Consultative examinations are medical examinations that Social Security sometimes sends disability applicants to in the course of processing a claim for disability benefits.
In cases where an applicant's medical records are "thin" (there isn't enough evidence) or where a disability applicant hasn't been seen by a doctor for six months or more, the Social Security Administration (SSA) will generally schedule a consultative exam.
If Social Security doesn't think your medical records have enough medical evidence to make a determination on your disability, the agency may want to get another medical opinion. The SSA can request that you go to a consultative examination with a doctor hired and paid for by Social Security. Or, the SSA might require you to take an additional test if results are missing from your medical record or out of date.
During the exam, the doctor will ask about your condition and go over your medical history. The doctor will try to assess your current situation and offer the SSA some insight into how your condition might prevent you from doing everyday tasks.
The doctors who usually perform consultative examinations (CEs) for the SSA are independent physicians who have contracted with the SSA to perform CEs. But in some situations, the SSA will ask your own doctor to perform the exam. You can even request that your own doctor perform the exam; the SSA could approve your request if your doctor has the right medical background for the exam.
For physical conditions, you'll be sent to an internal medical exam with a general internist (rather than a specialist like a neurologist).
For a cognitive, behavioral, or psychiatric condition, you'll be sent for a psychological evaluation. Exams can also include ophthalmological exams, blood work, and X-rays.
The purpose of a disability medical exam is to provide a recent snapshot of your conditions and various limitations, not for the purpose of delivering medical treatment.
What happens at the medical examination is at the discretion of the disability examiner ordering the exam. The examiner obtains only what is necessary for a decision to be made. That's why consultative exams usually only last about 15 to 20 minutes.
A consultative physical exam involves all of the elements of a routine physical examination, but may be much shorter. For instance, a medical assistant will usually check your blood pressure, heart rate, weight, and other routine measurements. Then, the physician will evaluate the part of your body that's impaired or will perform tests requested by the claims examiner, such as an exercise stress test.
While most disability examiners will first contact your treating physician for clarification on an issue or additional information, there are cases in which this may be impossible. Or sometimes a disability applicant has had very little medical treatment or all of their medical information is considered outdated for the purposes of the disability determination.
Getting an appointment letter for a Social Security medical examination means, at the very least, that your claim is actively being worked on. In some cases, it may mean that a claims examiner who is leaning toward making an approval needs to obtain additional evidence, such as an X-ray.
But a CE appointment can also mean that you have little in the way of medical records or you haven't gone to a doctor in a long time, which isn't a good sign for your claim. In such cases, the scheduling of a consultative examination may simply be a technical necessity before a claims examiner denies a claim (examiners are required to obtain "recent" medical evidence on which to base their decisions).
But since you won't know the reason for the exam, don't be overly concerned about having to go to one. You'll know soon enough; decisions often come out a month or two after the consultative exam, but how long it takes for a decision after an exam depends on various factors, including how quickly the doctor sends in the report.
Consultative medical examinations are not necessarily the best way to get evidence to decide a disability claim. For one thing, it will usually be the first time you're seeing the doctor who conducts the consultative exam. And although Social Security often sends a portion of your medical records to the physician who will conduct the CE (to inform the doctor of your medical history), some CE doctors don't read the file ahead of time.
Additionally, Social Security medical exams tend to be brief. It's a common complaint among applicants who have gone to CEs that the duration of the exam was only five to ten minutes. But sometimes Social Security doesn't require a comprehensive consultative exam; for example, the SSA might only need to see the results of an X-ray or a straight leg raise test.
If you don't go to the consultative exam that Social Security arranged for you, and you don't reschedule it, your disability claim could be decided without medical evidence from the consultative exam. In all likelihood, this means you'll be denied disability for failing to attend a consultative examination, and you would have to appeal to have your case looked at again. At that point, you would either have to pay to go to your own doctor or hope that the administrative law judge (ALJ) would send you to another consultative exam.
If you had a good reason for missing an appointment that you confirmed, the claims examiner will usually allow the exam to be rescheduled. A good reason would be illness, death in the family, or unexpected transportation problems.
To reschedule an appointment, call the disability claims examiner who set up the appointment. The appointment notice you received about the consultative examination should include the phone number to call. Write down the day and time you called and who you spoke to, in case Social Security later says that you didn't reschedule the appointment.
After the examination, the consultative physician will complete a written report that will include:
The doctor may also note things like your appearance, your punctuality, and whether you were giving your best effort at the exam or seemed to be exaggerating your symptoms.
Typically, the consultative physician will also make a statement with regard to what you're capable of doing in spite of your impairment—that is, an opinion as to your ability to perform work-related activities such as lifting, carrying, standing, walking, handling things, hearing, speaking, and so on. The doctor may include how many hours you can stand or walk and how many pounds you can lift.
And the report should include information on both of the following subjects:
The consulting doctor who performs your consultative exam will send the written report to the claims examiner who is handling your claim.
If you would like a report of the consultative exam to be sent to your doctor, you'll need to fill out the authorization form that was sent with the appointment notice. The form is called "Authorization for Release of Consultative Examination Report."
Updated July 21, 2023