What is the Consultative Exam?
If you’ve applied for Social Security disability (SSD) benefits and you get a letter telling you a consultative exam has been scheduled, you may be concerned about what that means. Here’s what you need to know about why consultative exams are scheduled, who conducts them, what you can expect at the exam, and how the Social Security Administration (SSA) uses them.
Why Does the SSA Schedule a Consultative Exam?
The simple answer is that the SSA will schedule you for a consultative exam when they need more information than is found in your medical records and other information you submit.
That can happen because you’re missing one or more tests they think are necessary to make a decision, or because your medical care has been poorly documented, or because your newest records aren’t recent enough. You may also be scheduled for a consultative exam if there appears to be a contradiction in the medical records provided–for example, one In short, a consultative exam may be scheduled any time the SSA decides it needs more or more current medical information.
Because a consultative exam can be ordered any time the SSA needs additional information, you shouldn’t read anything into being scheduled for an exam. You shouldn’t assume that it’s either a good sign or a bad sign.
How Will I Know If I Need a Consultative Exam?
There’s no way to know in advance of hearing from the SSA. They’ll review your SSD application and the evidence you and your medical providers have already submitted before determining whether they need more information to decide your claim. If they decide a consultative exam is required, you’ll receive a letter notifying you of your appointment.
Who Conducts a Consultative Exam?
In many cases, your own doctor may conduct the consultative exam. There are several reasons this can be preferable, including the fact that your treating physician is already familiar with your condition, your past treatment, and any testing that has been completed. However, if your own provider isn’t able to conduct the exam or prefers not to, the SSA will contract with another medical professional to handle the exam.
The doctor conducting the consultative exam is always an outside provider. The SSA doesn’t have doctors on staff who conduct this kind of exam.
What Happens at a Consultative Exam?
What happens at your consultative exam depends entirely on the type of information the SSA has determined it needs to decide your case. It may be a physical examination, laboratory work and/or other medical testing, a psychological exam, or some combination of the three.
Whether the exam is conducted by your own doctor or another provider the SSA contracts with, they’ll be provided with some of your medical information. The doctor who conducts the exam–whether your own provider or another physician–will also be provided with instructions about what is to be included in their report. Some types of conditions have their own specific instructions.
Consultative exams are often quite short. Ideally, the medical provider conducting the exam will be familiar with your medical history, either because they are your regular provider or because they have reviewed information provided by the SSA. But, the provider may not have received full medical records before your exam, and not every provider reviews the records before seeing you.
The consultative exam doesn’t involve any medical treatment or treatment planning. The sole purpose of the exam is for the SSA to gather additional information to help determine whether or not you meet their definition of disability.
Who Pays for a Consultative Examination?
The SSA pays for consultative examinations, even if they are conducted by your own physician. They also pay for any testing they request or that is required as part of the exam.
What Should I Do if I’m Notified of a Consultative Exam?
If you’re working with an SSD benefits advocate, reach out to them right away to let them know that you’ve received notification of a consultative examination appointment. Your advocate can help ensure that you are prepared with any information the physician may need from you at the exam and can explain in more detail what you can expect.
Know that consultative exams are not optional. If you’ve been scheduled for a consultative exam and don’t show up, If you don’t go to the exam, the SSA may determine that you are not disabled and therefore are not entitled to SSD benefits.
If you can’t make it to the scheduled appointment, you’ll need to contact the SSA as far in advance of the scheduled appointment as possible. If you have a good reason, you may be able to reschedule your exam. You may even be able to reschedule on short notice or after you miss your appointment, but only when you can show good cause, such as not having received notice of the exam or having a death in the family. But you shouldn’t count on being able to reschedule. If you’re scheduled for a consultative exam, it’s an important part of the SSA’s consideration process, and you could lose out on SSD benefits if you don’t cooperate.
Get Help with Your SSD Application or Appeal
Being approved for SSD benefits can be life-altering when you’re unable to work due to a medical condition. But, the process can be challenging, and most initial SSD applications are denied. Whether you’re just preparing to apply for SSD benefits and want to submit the strongest possible application and evidence or you’re appealing a denial, an experienced Social Security disability benefits advocate can be your best resource.
At Disability Help Group, fighting for the rights of disabled people and their families is all we do. Our advocates have deep knowledge of the SSD application and appeals processes and know what type of evidence the SSA is looking for when they consider your application. We are dedicated to ensuring that people with disabilities get the benefits they deserve. To learn more about how we can help, call 800-800-3332 right now, or fill out our contact form here.