Why Do I Need a Consultative Exam for SSDI?

During the course of an SSDI claim, the claimant seeking disability payments may possibly be sent for a physical or mental consultative exam. This exam is not conducted by a Social Security Disability doctor, as there is actually no such thing as an SSDI doctor, however there are unit physicians with Social Security Insurance who assist disability examiners in their decision making.

Doctors who perform consultative examinations for Social Security are impartial physicians who have commissioned with SSDI to perform such services.

When a Consultative Exam May Be Scheduled

Once a claimant has filed for SSDI based on disability, the case is transferred to the Disability Determination Services. At this point the examiner who has been assigned to the case will gather a wide variety of records in order to make a determination. In certain cases, the examiner may feel that the claimant’s medical records are not complete, or perhaps the claimant has not seen a doctor for a substantial length of time. If this is the case, a consultative exam will be scheduled.

The purpose of the consultative exam has nothing to do with delivering medical treatment, but is only to provide a recent overview of the claimant’s current condition, therefore blood work, x-rays and any other test the consultative doctor feels necessary will be performed.

What to Expect at a Consultative Medical Exam

Social Security consultative medical exams are typically brief—sometimes merely five or ten minutes.  Although it may seem to be a negative thing when you are sent for a consultative medical exam, it does, at the very least, let you know that your case is actively being worked on. Being sent for a consultative exam can even mean that the examiner is leaning toward making an approval, but needs a bit more medical evidence.

SSDI claims that the sole function of a consultative examination is to determine residual functional capacity—meaning what you are able to do in spite of your disability.

Your Rights at a Consultative Medical Exam

When you receive notice of a consultative exam—probably in the mail—it will likely not tell you that you have the right to have your own physician perform the exam. If your doctor agrees, inform your examiner so that all appropriate paperwork can be sent to your doctor. If your doctor refuses, take a friend who can be a witness to the time spent on your exam and write down everything you can remember, including questions asked and answered.

These are precautionary measures which can help you substantiate your case if you believe the exam was not thorough enough.

Talk to a Disability Attorney

In most all cases, it is definitely to your advantage to hire an experienced Social Security Attorney to up your chances of getting your claim approved, and once you are asked for a consultative medical exam, an attorney is crucial.