Social Security Medical Exam - the purpose of the Consultative Examination

When Social Security sends you to a medical exam, what is the purpose of this? Why do they do it? Can the results of a consultative exam have an impact on your case?

If you apply for Social Security Disability or SSI disability benefits, there is a fairly good chance you will be scheduled to go to a medical exam. Typically, this happens when an individual who applies for disability has not been seen by a doctor in recent weeks or months. It seems to happen on at least 1 out of every 4 cases.

Should you be concerned if you are notified by mail that you will have to go to a social security medical exam? Not at all. Such exams are really only for the purpose of obtaining recent medical evidence that will, in essence, allow the social security administration to close a case, i.e. to make a decision on a claim.

Why is this? While disability examiners need older medical records to determine when a person became disabled (which impacts how much back pay they will get and when medicare coverage will start), they are also required to have medical evidence available to them that is not older than 60 days in order to render a determination. Without such evidence, they are unable to make the determination that the individual is currently disabled.

Here are a few initial points to keep in mind:

1. CEs, or consultative exams, are ordered by disability examiners (application and reconsideration appeal) and also by judges at hearings. But more so by examiners.

2. An exam can be physical in nature, or it can be mental. If the exam is for a mental impairment, it may involve psychological testing (such as intelligence testing or memory scales to test impaired memory) or a psychiatric evaluation.

3. The exam will not be conducted by a doctor who works for the social security administration. Instead, it will be conducted by a doctor who has agreed to perform such exams, but, otherwise, is engaged in private practice. The exam can be performed by a claimant's own doctor if the person requests this and the doctor agrees to do this.

4. The exam will usually last less than thirty minutes, and sometimes as little as ten minutes.

5. The consultative exam will seldom ever provide the basis for either an approval or a denial of a disability case. In most instances, it is simply a procedural formality to go through when an applicant has not been to a doctor recently.

All of this said, a person still needs to go to an exam if one has been scheduled because failing to go can be a reason for denying a case (failure to cooperate). If you miss an appointment for an exam, a disability examiner will usually be willing to reschedule the exam. However, if you miss more than one, this can be a problem because the doctor who has agreed to do the exam may decline.

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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