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What to Expect When Seeing the Social Security Doctor

Gordon, Wolf & Carney  Aug. 31, 2023

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 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 Exam?

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 medical exam performed by a Social Security doctor. This consultative exam is not required for every applicant but is often requested by a claims examiner if they don’t feel they have enough medical evidence to approve your application or want a second professional opinion. 

What Will the Doctor Do?

The SSA contracts with numerous doctors and health care providers across the country, and the doctor they assign to you could theoretically be your primary care provider. More often than not though, you will have to be seen by a different doctor. The Disability Determination Services (DDS) will schedule an appointment for you and pay for any costs associated with it (including travel expenses if needed).  

The doctor will typically perform a physical or mental evaluation (depending on your claimed disability). This could include a range of tests such as X-rays, MRIs, blood samples, or any procedures specifically called out by DDS. They will question you about your medical history, your current state of health, your disability, and how it’s affecting your life and your ability to perform work. They will then write up a report based on their examination and send it back to DDS.

Importantly, the examining doctor does not make a decision on whether or not you are approved for benefits.  

What Should I Say/Not Say to the Doctor?

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. 

  • DON’T minimize or downplay your medical condition. 

  • DO be specific with your answers. For example, try to explain exactly where you feel pain and discomfort, how often it happens, and what it prevents you from doing. 

  • DO prepare for your exam. Make a list of your symptoms ahead of time so you won’t forget to include anything. 

  • DON’T say you are “fine” or “okay” when they ask how you’re feeling, even if you feel okay that particular day because this could be included in your report and used against you. 

What If I Don’t Agree With the Doctor?

If you disagree with your doctor’s assessment, the best step you can take is to call a reputable disability lawyer who can advise you on your options and help you file an appeal if necessary. An experienced lawyer can also help you formulate an approach to fight back against the doctor’s recommendation. This could include seeking out additional medical care and tests to support your claim. 

Seek Trusted Legal Guidance

If you’re applying for disability benefits and are concerned about going through a consultative exam, or have recently been denied coverage due to a negative exam report, call our team at Gordon, Wolf & Carney, attorneys in Maryland serving clients nationwide.