Do All CE Exams End in Denial? Everything You Should Know about Your CE Exam
When you apply for Social Security disability benefits (SSD), you’re probably expecting a notice telling you either that you’ve been approved or that your SSD application has been denied. However, some disability applicants receive something else: a letter from the Social Security Administration (SSA) informing them that they must attend a Consultative Exam (CE exam).
Being scheduled for a CE exam isn’t necessarily a bad sign. Here’s what you need to know about Consultive Exams.
What is a Consultative Exam (CE)?
A CE is a medical examination the SSA schedules to gather additional information about your SSD claim.
For example, a CE exam may be scheduled when:
- Necessary information from your past medical records is unavailable, such as when your medical provider does not cooperate or has passed away
- Necessary information is missing because tests haven’t been conducted
- Your condition may have changed, and up-to-date information is not available
A CE exam will only be scheduled if the SSA did not obtain sufficient information from your treating physician or physicians, and they are unable to fill that gap by requesting additional information from the medical professionals treating you.
Exactly what the CE exam involves depends on the information the SSA needs to collect. They will pay for the exam, but only for those elements necessary for their record–it isn’t necessarily a full medical examination or even a full assessment of the medical condition that is the basis of your disability claim.
As you can see, a CE may ultimately be to your benefit. If there’s not sufficient information in your application and supporting evidence to approve your claim, a CE exam may fill that gap. But it’s important to know what to expect and what will be expected of you.
Does a CE exam mean your claim will be denied?
No. It means the SSA needs more information before making a decision. Some claimants are approved after a CE. Others are denied, but that denial may have nothing to do with the exam, it may come down to how their records were documented before the CE was scheduled.
A CE report that conflicts with your other medical evidence can hurt your claim. If you’ve been telling your treating doctor your pain is severe, but you appear fully functional at the CE, the SSA will notice the discrepancy.
What to expect at a Consultative Exam
Exactly what happens at your CE exam will depend on your medical condition and on what information the SSA believes is necessary to complete your file. You may be asked to undergo a physical examination, a mental health examination, or diagnostic testing. The examiner will ask you questions about your condition, your daily life, and limitations.
You will be asked for identification. Depending on your condition, you may also need to bring medications and/or medical equipment such as a walker.
Note that the CE report will include more than test results and medical observations. The examiner will also pay attention to things like your mobility when you arrive at the exam, whether someone has accompanied you, and even how you got to the exam.
During the exam, you’ll want to take notes about the interaction. For example, it’s helpful to note the questions you were asked and how you responded. If you can’t make sufficient notes as the CE proceeds, write down as much as you can remember about how the CE exam went as soon as you leave. You can also bring an observer to act as a witness, and they can take notes as well.
How long does a CE exam take?
It varies. The SSA sets minimum durations by exam type. A general physical has a 20-minute minimum. Psychiatric evaluations often run an hour or more. Specialized testing adds time. Plan to be there for a full morning or afternoon.
Who Can Conduct a CE?
The doctors who perform consultative examinations for SSD claims do not work for the Social Security Administration. They’re independent medical professionals the SSA pays to conduct CE’s and complete reports according to SSA standards. You won’t be asked to make any payment for the exam or testing, and your medical insurance company won’t be billed. In some cases, your own doctor may conduct the CE exam.
What happens after the CE?
The examiner submits a written report to the SSA’s Disability Determination Services (DDS), which uses it, along with all other evidence in your file, to make a decision. Most decisions come within weeks to a few months of the exam.
You can request a copy of the CE report in writing. If it contains errors, misdescribes a condition, or underreports a limitation, you can address them in an appeal.
Tips for Your SSDI Consultative Exam
While being scheduled for a CE isn’t necessarily a bad sign, you can hurt your Social Security disability claim
Here’s what you need to do:
- Show up, and be on time. If you’re late, the examiner may not see you. If your disability prevents travel to the exam location, contact the SSA promptly after receiving the notice, accommodations exist but must be arranged in advance.
- Follow any prep instructions, such as fasting requirements.
- Bring your ID, medications, and any aids or prosthetics.
- Before the exam, review your symptoms and treatment history so you don’t leave out something relevant.
- Answer honestly. Don’t exaggerate, but don’t minimize either. Describe your worst days, not your best ones. Be specific about how your condition affects daily tasks.
- Don’t refuse any part of the exam. If you can’t complete something, explain why and let the examiner document it.
Talk to an Experienced Disability Benefits Advocate
Securing Social Security disability benefits can be tough, even when you have a serious disability. Most SSD claims are initially denied. Some claims are denied for technical reasons, like insufficient work credits. But medical decisions are more nuanced. Often, whether or not your SSD claim is approved depends on submitting the right type of evidence in the right form to make it easy for the SSA to see that your condition meets their criteria.
Working with an experienced disability benefits advocate from the beginning allows you to put together the strongest possible application and to be well-prepared for a CE, a request for additional information, or anything else that arises. If you’ve already applied and been denied, the same is true for your appeal. You have the opportunity to submit additional supporting documentation, even at the reconsideration stage.
Our disability advocates have helped thousands of disabled people receive the benefits they deserve. Whether you’re just starting the process or need to appeal a denial, Disability Help Group is here for you. To learn more, call (800) 800-3332 or contact us here now!
FAQ
Can I reschedule my CE?
Yes, but contact the SSA right away. The SSA will generally reschedule for a legitimate reason, illness, a conflicting medical appointment, or transportation issues. Don’t skip the exam without prior contact. Missing it without notice can result in a denial.
What if I disagree with the CE examiner’s findings?
You can’t challenge the report before a decision is made, but you can address it in an appeal. At reconsideration and beyond, you can submit a statement from your treating physician explaining where the CE report differs from your treatment record. An administrative law judge at a hearing must weigh all the medical evidence, not just the CE.
Will the examiner ask about my daily activities?
Yes. Examiners routinely ask what you can and can’t do day-to-day, cooking, driving, climbing stairs, and concentrating for extended periods. These aren’t casual questions. The answers feed into the SSA’s assessment of your residual functional capacity (RFC), which determines whether there is any work you’re considered able to perform.
What if the CE doctor doesn’t specialize in my condition?
The SSA is supposed to assign an appropriate specialist when one is needed. If you believe the CE was conducted by someone without relevant expertise, document it and raise it with your advocate. It may be grounds for challenging the weight given to the CE report on appeal.
What if I can’t travel to the exam location?
Contact the SSA immediately after receiving the notice. The SSA may arrange transportation, approve a closer location, or, in some cases, allow a home visit. This must be requested in advance.
