What is the Purpose of the Social Security Disability SSI Medical Exam, or CE?

In a fairly large percentage of cases, a person filing for disability benefits with the social security administration (in either the Social Security Disability program or the SSI program: claims in either program are evaluated in exactly the same manner) will be notified that they have to go to a scheduled appointment for a medical examination, or a psychatric examination, or psychological testing. These exams are known as consultation examinations and are referred to by disability examiners, disability attorneys, and disability hearing judges as a C.E.

The CE, or consultative examination, is conducted by either an M.D. (this would be for physical impairments or psychiatric impairments) or, in the case of intelligence and/or memory testing by a psychologist who usually holds a master's degree.

As opposed to myth, the CE, which is sometimes referred to as the "social security medical exam" is not conducted by doctors or therapists who work for the social security administration in any capacity. Quite the contary, these individuals are typically in private practice and have been contracted to A) perform evaluations and examinations on disability claimants and B) report the findings of their exams to social security within X number of days of performing the exam.

Who decides that a claimant will need to go to a consultative exam? The disability claim decision-maker does this. So, in most cases, an examination will be scheduled by a disability examiner (disability examiners make decisions on claims at the disability application and reconsideration appeal level).

However, administrative law judges who make decisions on claims at the disability hearing level will sometimes also require that a claimant go to a consultative exam.

What is the purpose of the consultative examination? Officially, the purpose of any CE (physical or mental) is so that a disability examiner or judge may obtain additional medical record documentation. Additional documentation will usually be needed in cases where:

A) the claimant has not been to a doctor or treating specialist for more than ninety days or

B) the claimant has listed a condition on the disability application for which they have never been treated, or been diagnosed.

Typically, what triggers the scheduling of an examination is the fact that the claimant has not been recently treated. This is because Social Security Disability and SSI disability claims cannot usually be decided (either approved or denied) if the claimant's file does not contain "recent medical evidence". For the purposes of the social security administration, this means having at least some medical evidence in the file that is not older than sixty days.

continued at: Social Security Consultative Medical Exams and How they affect Disability Claims

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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