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According to data put out by the Social Security Administration (SSA), there were 9,243,999 people in the country who received Social Security benefits for a disability in 2021. For these recipients, the financial aid that comes from programs like Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) represents a critical lifeline.
If you are currently applying for these benefits and are concerned about whether you’ll be approved, specifically regarding a consultative exam with the Social Security disability doctor, contact us at Gordon, Wolf & Carney to learn about your options. Our home offices are located in Towson, Maryland, but we’re able to represent clients nationwide.
What Is a Consultative Examination?
Anyone who’s received Social Security disability benefits for any length of time will be familiar with a consultative exam. On the other hand, for those newly entering the system, this exam can often be a source of stress and uncertainty, so it’s crucial you educate yourself about this process.
Before digging into what exactly a consultative exam is, you should know about the different sources of disability insurance that are available and the requirements for qualifying for each to better understand why the exam is necessary in the first place:
- Social Security Disability Insurance (SSDI): SSDI is the largest federal aid program for disabled Americans and provides cash benefits to anyone (regardless of income or assets) who has paid into the Social Security system and has become disabled and no longer able to work due to their condition.
- Supplemental Disability Income (SSI): SSI is a needs-based program that supplements the benefits of qualifying individuals who don’t exceed the established income or assets caps. This money is meant to help disabled individuals or those 65 and older pay for basic cost-of-living expenses, and it is not contingent on having paid into the system or worked previously.
Both programs also have requirements in place to ensure the beneficiaries legitimately need these services, and this could include a disability medical exam performed by a Social Security disability doctor. This consultative exam is not required for every applicant, but it is often requested by a disability examiner if they don’t feel they have enough medical evidence to approve your application or want a second professional opinion.
What to Expect at a Social Security Medical Exam
The SSA contracts with numerous doctors and health care providers across the country, and the doctor they assign to you could theoretically be your own doctor. More often than not, though, you will have to be seen by a different doctor. The Disability Determination Services (DDS) will schedule a medical appointment for you and cover any costs associated with it, including travel expenses if needed.
The contracted doctor will typically perform a physical exam or mental exam, depending on your claimed disability. Tests performed during the exam may include X-rays, MRIs, blood work, or any procedures specifically called out by DDS. The doctor will ask about your medical history, your current state of health, your disability, and how it affects your daily life and your ability to perform work.
Physical exams usually involve checking things like range of motion, strength, balance, reflexes, gait, and posture. Mental status exams may include questions and simple tests related to mood, memory, concentration, reasoning, and daily functioning. Most exams take roughly 15 to 30 minutes, though the length can vary depending on the type and complexity of the evaluation.
After the exam, the doctor prepares a report summarizing their findings and sends it to DDS. Importantly, the examining doctor does not decide whether you are approved for benefits; their role is solely to document your condition for SSA’s review.
What Should I Say/Not Say to the Doctor During My Disability Exam?
Because so much is riding on the consultative exam, you should be aware of how your words and actions can positively or negatively affect your results:
- DO be honest with your doctor and don’t exaggerate your symptoms. Describe your pain, limitations, and difficulties accurately. Overstating your symptoms can hurt your credibility, while understating them can make it seem like your condition is less serious than it is.
- DON’T minimize or downplay your medical condition. Even if you feel better on the day of the exam, explain the regular impact your disability has on daily life and work.
- DO be specific with your answers. For example, try to explain exactly where you feel pain or discomfort, how often it happens, and what it prevents you from doing. Mention particular activities or tasks that are difficult because of your condition.
- DO prepare for your exam. Make a list of your symptoms, medications, and functional limitations ahead of time so you won’t forget anything important during the appointment.
- DON’T say you are “fine” or “okay” when asked how you’re feeling, even if you feel okay that day. The doctor will include your statements in their report, and this could influence how your claim is evaluated.
- Keep your focus on your condition, not the outcome. Avoid making statements about whether you think you should or should not be approved for benefits. The doctor’s job is to document your limitations, not decide your claim.
What Happens After I See a Disability Doctor?
Once your consultative examination is complete, the process does not end there. Here is what typically happens next.
1. The Physician Prepares the Report and Sends it to DDS
After the exam, the physician will prepare a detailed medical report outlining their findings. This report typically includes observations from the physical or mental examination, test results (if any were performed), and the doctor’s professional assessment of your functional limitations. The report is then sent directly to DDS.
2. DDS Reviews the Report and Other Evidence
DDS will review the consultative exam report alongside all other available evidence in your file. This includes your medical records from treating physicians, hospital or clinic notes, prescription history, imaging results, and any statements you’ve provided about how your condition affects your ability to work and carry out daily activities.
3. DDS Requests Additional Evidence
In some cases, DDS may determine that the consultative exam is not enough to make a decision. If that happens, they may request additional medical records or other evidence from your providers to clarify specific issues. This can extend the processing time of your claim, but it is not unusual.
4. Disability Examiner Makes a Decision
Once all evidence has been reviewed, a disability examiner (not the examining doctor) makes the initial decision on your claim. You will then receive a written notice explaining whether your application has been approved or denied. Processing times can vary widely, but many applicants wait several weeks to a few months after the exam before receiving a determination.
Again, it is important to understand that the consultative doctor does not have any role in approving or denying benefits. Their job is strictly to provide an objective medical snapshot that DDS uses as part of its overall decision-making process.
What If Your Claim Is Denied After a CE?
Receiving a denial after going through the Social Security disability process can be frustrating and discouraging, especially after completing medical exams and providing detailed information about your condition. However, a denial does not necessarily mean the end of your claim.
Many disability claims are denied at the initial stage, and applicants still have options available. In most cases, you have the right to appeal the decision and ask for your case to be reviewed again. During the appeals process, you may also have the opportunity to submit additional medical evidence or clarify information in your file.
Because the process can be time-sensitive and complex, many applicants choose to speak with an experienced attorney to better understand their options and next steps.
Do You Need Help With Your Disability Claim? Contact Our Disability Lawyers
If you’re going through the Social Security disability process and are concerned about a consultative exam, or have recently been denied benefits due to a negative exam report, call our team at Gordon, Wolf & Carney, disability lawyers in Maryland serving clients nationwide. For more than 25 years, our attorneys have helped individuals navigate every stage of the disability process, from initial applications through appeals. Let us help you build a strong claim so you can secure the benefits you need.
