Can you Refuse to go to a Social Security Medical Examination?

Yes, you can refuse to go to a CE, or consultative examination, commonly known as a "social security medical examination". However, its typically not wise.

You have to consider why a disability examiner wants to schedule a claimant for such an exam in the first place.

A) Usually, its because a claimant has not been to a medical treatment source in the last ninety days.

B) Sometimes a CE is scheduled because a claimant has never been treated for a condition on the disability application. Depression is a good example of this. Many individuals list depression on a disability application without ever having received treatment for depression from a mental health treatment source, or even from their own general practitioner (often in the form of an RX for an anti-depressant).

C) In other instances, a claimant will be sent out for a simple xray if an imaging report is not available from the claimant's list of medical treatment sources.

Flatly refusing to go a consultative exam can potentially result in a case being denied for failure to cooperate. And for a claimant who simply has no recent medical record documentation, not going to a consultative exam can only lead down the path to a denial.

Some claimants are understandably nervous about going to consultative exams, possibly because they fear some level of bias on the part of a "social security doctor". However, the doctors who perform such exams DO NOT WORK FOR THE SOCIAL SECURITY ADMINISTRATION. They are independent physicians who perform examinations on a contract basis. Having said that, though, it's true that, when the topic arises, a large percentage of claimants who have gone to consultative exams will report that the examining physician was brusque or seemed to exhibit behavior that indicated a biased stance.

Generally, if a claimant goes to a physical consultative exam for a Social Security Disability or SSI disability case, what they'll find is that ---

A) the exam will be fairly short
B) the doctor may be somewhat rude (a common complaint)
C) the doctor will ask them very little
D) and, topping it all off, the doctor will typically know little about their medical condition or history -- disability examiners will sometimes send the examining physician excerpts from the medical record to apprise them of the claimant's medical history, but there's no guarantee that the examining physician will read the information.

However, what a disability claimant will not be privvy to is the fact that, at the initial claim and reconsideration levels, consultative exams are usually scheduled so a disability adjudicator can simply obtain recent documentation for the file...so the case can be closed.

None of which changes the fact, of course, that if you are scheduled to go to an examination appointment for your disability claim, you really need to go.

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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