Why does Social Security think they know more than my doctor?

Someone made this statement recently in a forum. "I don't see how the social security doctor will determine my illness better than the psychiatrist I've gone to for two years.

Guess what? This individual is completely right. In fact, claimants are generally sent to a social security doctor (in actuality, these are private practice physicians, psychiatrists, and psychologists who are paid to perform consultative exams (CE) for social security; in other words, they don't work for social security) for three reasons.

1. To obtain recent medical record documentation if you haven't been seen for your condition in some time (usually more than 60 days). This can take the form of a physical CE or of a mental CE that can either be a mental status exam, an IQ test, a memory scale, or a full psychiatric exam.

2. To obtain special testing. You could be sent out for xrays if you've had a bone break, or to spirometry (breathing test) if you have respiratory problems, or to audiometry if you have hearing loss, etc, etc.

3. You could be sent to mental testing even if you did not allege a mental condition on your disability application but there was some indication of this in your file (believe it or not, even if your family doctor who treats you for back problems writes the word "depression" one time in your file).

None of these purposes, however, has anything to do with rendering a final disability determination on your case. The consultative examiner simply examines you, or performs his or her testing, and later submits a CE report to the disability examiner (disability examiners are the individuals who make decisions on disability applications and reconsideration appeals while disability hearing decisions are made by federal judges).

How much weight does the CE report carry? My own estimation is "not a lot". As a disability examiner, I saw a very small percentage of claims that were approved on the basis of CE exam reports.

What then, you may ask, is the purpose of even going to such an exam? Truthfully, most of these exams are scheduled for just one reason. So the disability examiner can say "Yes, I have recent medical documentation" and then close the case.

So, the lesson to be learned here if there is one, is this: when you file for disability, don't assume that if you haven't been going to a doctor that you can be approved simply by going to a social security medical exam. It could happen. But its more likely that, without a record of receiving treatment from your own doctors, your chances of winning disability benefits will be slim.

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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