An individual applying for Social Security Disability Insurance benefits may receive a letter directing them to see a doctor for a consultative examination. Some applicants find this to be confusing and frustrating because they have already submitted medical records as part of their application. The Social Security Administration is seeking additional information to make a disability determination.
If you receive a consultative exam letter, you should cooperate and see the doctor as directed. The SSA selects the doctor and pays for the examination. The doctor assesses the disabled person’s ability to perform the demands of job activities and any limitations they have.
The Social Security Disability attorneys at Morgan, Collins, Yeast & Salyer help disabled Kentuckians seek disability benefits and appeal denied SSDI claims. Our disability lawyers have represented many clients who have been asked to undergo consultative examinations. Let us apply our knowledge and experience to guide you through the disability claims process. You have a better chance of success if you have experienced legal representation.
The Social Security Administration’s Consultative Exam
If you’ve been asked to submit to a consultative examination (CE), it will come from the Kentucky Cabinet for Health and Family Disability Determination Services. If the agency cannot get sufficient information from your treating physicians, the DSS will arrange a consultative exam with another physician to gather more information.
A consultative exam may be a physical or mental examination or a diagnostic test. If a CE is a psychiatric exam or a speech and language exam, you may be able to request a telehealth consultative exam or an online appointment with the medical provider.
The doctor who conducts the exam will provide a report for the Social Security Administration. The doctor will be asked to provide a statement about your ability, despite your disabilities, to engage in work-related activities. You will not be charged for this examination or test.
When an administrative law judge decides they need the results of a specific medical test to make a decision during the appeals process, the DDS will arrange for the test to be performed. The judge’s request is formally known as a “Request for DDS Assistance in Obtaining Consultative Examination(s) and Other Medical Evidence as Indicated” [HA-4489].
Before requesting a consultative exam, the DDS medical consultant will review your file and determine whether a requested diagnostic test or procedure involves significant risk to you. Some diagnostic tests, such as tests requiring treadmill exercise, may pose significant risks to some claimants.
The Doctor Visit: Not a Guarantee of Approval or Denial
A request to undergo a consultative exam isn’t necessarily a good sign or bad sign for your disability benefits application. It’s a doctor’s exam. It doesn’t automatically mean your SSDI application will be denied or approved. It means they don’t have enough evidence to reach a decision. If you decline to undergo this exam, you will jeopardize your chance to receive benefits.
The DDS will select a medical provider who is qualified and willing to perform the exam. The agency is to consider the treating doctor identified in your file as a preferred source to conduct the consultative exam.
An ALJ may request that the DDS not direct you to a particular medical provider for a CE if they have a good reason, such as a conflict of interest.
The DDS may decline to use a particular medical provider to conduct a CE for good reason, such as that they have a history of not providing timely or complete reports.
As the disability applicant, you may also object to a particular medical provider. As your Social Security disability lawyers, we can help you file this objection. The DDS will determine whether there is a good reason for the objection and, if there is, reschedule the examination with another medical provider.
How a Consultative Exam Could Benefit You
A CE may provide the evidence necessary to obtain Social Security Disability benefits. When the SSA requests a CE, it’s because medical records documenting your disability are not thorough enough or your test results need to be updated before a decision is made.
Because a CE request is typically for a specific test, it is generally focused on a single aspect of your medical condition that has not yet been fully explained. The SSA wants all the information necessary to determine your eligibility for SSDI benefits.
Evidence added to your file after a CE should confirm the extent of your disability and its impact on your ability to work for a living and maintain gainful employment.
Could There be Bad News From a CE Doctor Visit?
Unfortunately, not all consultative exams lead to favorable outcomes for the claimant. The doctor may offer the opinion that despite your disabilities, you can still perform some work, even if you cannot return to your former job. The Department of Disability Services may decide that the examination results do not prove that you are disabled according to the Social Security Administration’s strict definition. But you have multiple opportunities to appeal a denied Social Security Disability claim.
A knowledgeable Social Security Disability lawyer can refer you to a specialist for a second opinion to supplement your medical record and request a hearing before an administrative law judge. During a hearing, the attorney can offer additional medical evidence and persuade the judge of your qualifications for SSDI benefits. Our Social Security Disability attorneys understand the types of evidence that judges are seeking to grant benefits.
Consult a KY SSDI Lawyer about Medical Evidence and a CE Request
There are multiple sources of medical evidence to use in an SSDI benefits claim. At Morgan, Collins, Yeast & Salyer, our Kentucky SSDI attorneys can help you know what to expect during a consultative examination and help you present documentation of your disability and qualifications for benefits.
Let a Kentucky Courage attorney at Morgan, Collins, Yeast & Salyer help you appeal a denied SSDI claim. We will handle the paperwork and represent you throughout the claims process. Contact us today at (877) 809-5352 or online to schedule your free case evaluation.
