Medical records are collected by disability examiners at the Initial and Reconsideration levels of a Social Security disability case to provide evidence to determine whether you meet the criteria to be considered disabled under the Social Security Administration’s laws.
A consultative examination (CE) may be scheduled by the Disability Determination Services (DDS) to obtain more evidence regarding your medical conditions. Consultative examinations can be performed by your physician; however, many physicians or mental health practitioners are not qualified to perform these types of evaluations. In these cases, Social Security will schedule an appointment with an outside medical provider. These examinations are scheduled based on the type of examination required, location, and availability. The providers who perform CE’s are familiar with the Social Security Disability program and the types of evidence necessary to evaluate a claim.
Consultative examinations are not scheduled in every case. The determination of whether a consultative examination is required is made by a DDS examiner at the Initial or Reconsideration level, or by an Administrative Law Judge (ALJ) at the hearing level. If you have had adequate medical testing, treatment, therapy, etc., a consultative examination may not be necessary.
The Social Security Administration pays for these evaluations, so there is no cost to you or your insurance company. Also, if you need to travel more than 50 miles one way to reach the appointment location, then you may be eligible to receive mileage reimbursement. DDS does not provide transportation to CE’s, so you must make your own arrangements.
There are several types of consultative examinations, i.e., psychiatric, mental status, orthopedic/musculoskeletal, internal medicine, and other specialized evaluations. These examinations are non-invasive. Your CE provider will be supplied background information and your medical history by the DDS office prior to your appointment. If you don’t speak English, an interpreter will be provided, also, at no cost you.
You will be notified that a CE has been scheduled for your case via mail from the DDS office, typically at least one month prior to your examination date. An acknowledgement form also will be mailed with the notice and you will be asked to sign and date it, indicating that you are aware of the appointment and will attend. If the scheduled date does not work for you, the DDS office should be contacted immediately. Ultimately, it is at the discretion of the disability examiner whether a CE will be rescheduled. Generally, appointments are rescheduled only if you have a good reason for being unable to attend (i.e. previously scheduled medical appointment, illness, etc.). It is in your best interest to attend the CE at the scheduled date and time to avoid delay in a decision in your claim. If you fail to attend your CE, DDS will make a decision on your case based on the medical evidence already in the file, often resulting in a denial.
A release form will be mailed with your CE notice, which you should sign to authorize the release of the report to your medical provider and/or disability representative. It is wise to have this report released to your medical provider so the test results can be explained to you.
CE examiners are used solely to provide additional medical evidence for your claim. They do not “work for” DDS to discount your allegations regarding your medical condition. They simply are called upon to provide supplemental evidence regarding how your medical conditions affect your ability to work. It is important to fully cooperate with the CE provider so they may get a complete understanding of your medical conditions.
Once the CE is completed, the provider will send the report to the DDS examiner or ALJ. The findings of this report are then reviewed and compared with your medical records. It is important to note that even if the findings in a CE support your allegations of disability, it does not mean that you will be found disabled. That determination is ultimately up to the disability examiner or ALJ.
Your representative will help you understand what to expect if a Consultative Examination in the evaluation of your disability claim.