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What happens in a Social Security Disability consultative examination?

Written by Ankin Law Office

Inadequate medical evidence is a common reason for Social Security Disability claim denial. However, when people seeking SSD benefits in Chicago fail to provide all of the evidence necessary for a final claim decision, the Social Security Administration may order a physical or mental consultative examination. The purpose of the consultative exam is to bring the applicant’s medical record current or obtain missing medical evidence.

Exam structure

During a physical consultative exam, a physician conducts a physical examination before focusing on the applicant’s disabling condition. The physician also completes any specific tests the SSA has requested. Based on the examination and tests, the physician produces a description of the disabling condition and an evaluation of the applicant’s ability to work.

Mental consultative examinations focus on a person’s mental conditions or impairments. A psychiatrist or psychologist may test a person’s memory, awareness or language skills during a mental consultative exam. The professional conducting the exam may also directly evaluate a person’s diagnosed mental illnesses and disorders. The nature of the individual’s injury or illness determines whether the SSA orders a psychological exam, psychiatric exam, memory scale exam or mental status exam.

Whenever possible, the SSA schedules the consultative exam with an applicant’s treating physician or other treating medical source. However, if a treating source appears unreliable, declines to perform the exam or cannot provide the information the SSA needs, a consultative exam with an independent physician may be ordered. An applicant can also see an independent physician if the applicant has a legitimate reason to desire an examination from a new source.

Accuracy issues

Consultative exams involving independent physicians may not always support an applicant’s assertion that he or she is disabled. The following factors can result in unfavorable evaluations:

  • Poor preparation — an independent physician receives each applicant’s medical file prior to the consultative exam. However, some physicians may not look at the file or review it thoroughly before the exam.
  • Lack of doctor-patient relationship — an independent physician lacks the thorough knowledge of the patient’s medical history that a treating physician possesses. Even if an independent physician peruses the applicant’s medical records, these records may not capture the full scope of the disabling condition.
  • Time constraints — consultative exams are typically conducted quickly. Some exams take just 5 to 10 minutes, and most are completed in less than 20 minutes. This can further limit the physician’s understanding of the applicant’s condition.

Considering these potential issues, applicants benefit from providing as much medical documentation as possible when they initially apply for benefits. Otherwise, applicants may risk claim denial and the delays associated with subsequent appeals.

Categories: Social Security