SSA Medical Exam and your own Physician

SSA Medical Exam and your own Physician

"Dear Tim Moore,

My wife has been receiving SSA Disability benefits for about 8 years. All of a sudden SSA wants to send her to their doctor for an exam. I assume, to try and kickher off the rolls. They requested a report from her treating psychiatrist, (she sees him weekly), her psychiatrist said he sent it in. SSA scheduled her for an exam anyway, (in about two weeks from now.) Does she have a right to "insist" that they use only her doctor's report.? If not, does her treating physician have a right to be present and participate in the exam as he does under the Department of Labor's workers' compensation program? Thank you for your time."

Social Security conducts The Continuing Disability Review for SSD and SSI claimss on most Social Security and SSI disability beneficiaries. In fact, when a disability claim is approved, a future disability review date is set. Generally, these review diaries are set for three or seven years depending on the age and medical condition of the disability beneficiary. So this is nothing unusual.

As to the question about having a right to insist that they use your spouse's treating medical professional's records only, Social Security does not allow anyone the right to determine whose medical records they can use.

However, they generally give weight to the treating medical professional. Has your spouse made sure the disability examiner has received the necessary records from her doctor? The fact that her doctor says they were sent does not mean that the disability examiner received them.

Lastly, Social Security does not allow other doctors to be present at their consultative examination. In fact, they generally would not schedule any examination if they have received current medical records for the disability beneficiary; which, tells me that either they did not receive the records, or they do not address your spouse's functional ability, or they just need more clarification with regard to your spouse's condition.

I would suggest to you that you have your spouse ask her treating physician to complete a physician statement. The statement should include her diagnosis, prognosis, and treatment, response to treatment, limitations, and medications.

The statement should also include a statement or opinion as to your spouse's ability to perform routine activities including her ability to sustain employment when her limitations of her condition are considered. There is a fairly good chance if you do this your wife would not have to go to the exam. Of course, it may just be as simple as they have not received your spouse's medical treatment record records.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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