Consultative Exam

If you are When you apply for SSDI, you must include comprehensive medical evidence that shows your disability is severe enough to qualify for benefits.

For SSDI, this means that your disability prevents you from working and is expected to last at least 12 months or end in death. Every disability claimant will be asked to provide documentation of their medical condition, but if the SSA finds the evidence to be insufficient, they may schedule you for a consultative examination (CE).

Common Questions About the Consultative Exam

What is a consultative exam?

A consultative exam is a medical examination that may be necessary for some Social Security disability claimants to complete their application process. The type of exam will depend on your individual needs and could be a physical examination, mental consultative exam, or a simpler procedure like a blood test or X-ray. This exam is entirely free and paid for by the SSA, but it’s essential that you do it or your application will be left incomplete and you won’t be considered for benefits.

When you first file a claim for SSD benefits, you will be assigned a disability examiner whose role it is to examine and analyze your application to see if it meets the criteria for earning benefits. If they find they need more information they will order the exam.

Do I need a consultative examination?

Not everyone will need a consultative exam, but if their current medical history is insufficient or lacks a specific test it will be necessary. It is only requested when Disability Determination Service (DDS) requires additional information that was not provided in the initial application process.

When you first receive notice of your exam, it’s always a good idea to review your current medical records. Make sure that any missing information was not accidentally left out. If you do have additional medical documentation, you may be able to forward the existing exam or test result to DDS and bypass the consultative exam. However, in most cases, you will need to attend.

Who performs the consultative exam?

Consultative examinations are performed by an independent physician who has contracted with the SSA but is not employed by the SSA. In some cases, you may be able to have your current medical provider perform the exam or test, but this will need to be approved ahead of time. If you are asked to have a mental health exam this must be done by a psychologist or psychiatrist and cannot be a therapist or counselor.

What does the consultative examiner do?

Your consultative examiner is only contracted to perform the specific test or exam that was ordered, and to prepare a consultative exam report for DDS. They do notdetermine whether or not you’ll qualify for disability benefits and they will not provide any advice or courses of treatment.

This is strictly an assessment and they will not evaluate the results in terms of your disability benefits—this can only be done by DDS using the requirements laid out by Social Security disability law. DDS will use both the information you provided in your application and the new evaluation from your exam to make a determination.

Can I choose a different CE doctor?

Sometimes. The SSA works with thousands of medical providers across the country who are able to perform these exams and will make every attempt to find a provider that’s close by and convenient. If for some reason you have an issue with the provider they selected, you can request that a new doctor be used though you would need a valid reason and this could result in a delay to your claim.

Can my personal doctor perform the CE?

In some cases, DDS may request that your current provider perform the exam if they are qualified, but the doctor can refuse this request in which case you’ll need to see someone new.

You can also request to have your personal doctor perform the exam, but the SSA may refuse this request for a couple of reasons. One, they may be looking to confirm or clear up confusion from an existing exam performed by your doctor and therefore would like someone new to do it. Or, they may not trust your doctor or your doctor simply isn’t licensed to perform the type of exam that was ordered.

If the procedure is simple such as a blood test or X-ray, you can usually schedule this with your current doctor and send over the results to DDS, but for a comprehensive mental or physical examination, your options may be limited.

You can also try contacting your doctor personally to see if they are willing and able to perform the exam. The doctor must be willing to accept payment from the SSA and then write up a report afterward. In some cases, your doctor can then contact your disability examiner directly or you can make the request. It will usually increase your chances of approval if you put your request in writing and then follow up with a phone call.

What is in the final consultative exam report?

At the end of your exam, the treating physician will write up a report (the consultative exam report) along with their findings and test results and send it to the SSA.

This report should be limited only to the exam that the doctor performed, but will also often include a diagnosis based on their findings and a general statement about how your disability is likely to affect your everyday life. This could include an analysis of how long or much you’d be able to work, stand, or sit, or any mental or physical restrictions of your condition.

The doctor will also take into account any information you provided to them during the exam such as previous treatments, medications, or a description of how your disability has impacted your life.

What if I’m unable to travel to the doctor’s office?

Oftentimes, your exam will be scheduled for you with a nearby provider. If you know you’ll be unable to travel to the doctor’s office to have your exam done, you should contact your disability examiner immediately to make alternative arrangements.

If your disability prevents you from being able to travel to your exam, federal law requires that the SSA make arrangements for the physician to come to you, but you need to be proactive in requesting this. You may need to file a written request outlining why you’re physically unable to travel.

What if I miss my appointment?

If you miss your exam and fail to reschedule it, it could mean that your claim will be denied due to lack of evidence. It’s always better to be proactive about any potential conflicts. As soon as possible after your missed exam, you should contact your disability examiner and explain the reason why you missed it.

In general, they will only excuse it if the conflict was unavoidable such as an illness, a death in the family, or an unexpected loss of transportation (like your car breaking down). You may then be able to reschedule your appointment, but know that this might further delay your claim.

Preparing for Your Consultative Exam

Double check time and place

Your appointment will likely be scheduled for you and you should make every effort to be there on time. Plan ahead and if you anticipate any reason you may not be able to make it, contact your disability examiner to reschedule or for help arranging transportation. It’s common for a disability claim to take several months to be approved and any delays will only increase this timeline. While there are provisions in place to provide retroactive benefits (like SSDI back pay) for claims that take longer than normal, you still want to do everything you can to ensure you make it to your appointments.

Bring documentation

Ideally, your medical record will have been transferred to the CE physician, but this won’t always be the case. The more documentation you can bring regarding past tests or diagnoses, the more information the new doctor will have to work from. Focus on objective tests like x-rays, MRIs, EMGs, or blood tests, and include any prescriptions medication you are currently taking,

Tell your story

In all likelihood, this is the first time this provider has met you and they have no knowledge of your medical history. Be prepared to describe your condition and how it affects your day-to-day life. When did it begin? Did it have a slow onset or was there a single event like an injury or car accident that caused it? Be as specific as possible but don’t try to exaggerate or underplay your disability. Explain how your disability affects your physical and mental capabilities, any assistance you regularly need to help you perform daily tasks, your ability to take care of your personal hygiene needs (are you able to get in and out of the bathtub safely, use the toilet, dress yourself, etc.).

Also, talk about your treatment history. What medications have you taken in the past? Have you had any procedures done? Have you ever had to go to the emergency room or hospital due to your condition?

Consider bringing along someone to help

Consultative exams can be a stressful experience and it can be helpful to bring someone along to your appointment who may be able to help. This should be someone who you trust and who knows about your disability (like a spouse, family member, or close friend). Talk with them before the appointment and go over the details of what you plan on telling the doctor with them. This way if you get confused, overwhelmed, or flustered during the exam they can fill in the holes and ensure your story is heard.

Consultative Exam for Social Security Disability Benefits

Social Security disability benefits provide much needed financial support for Americans who are unable to earn to their full capacity due to their disability. The application process can take a long time and will require you to provide detailed personal information about yourself and your finances as well as any medical treatment you’ve received as it relates to your disability.

In some cases, you may be asked to attend a consultative examination that’s scheduled by your DS examiner. These are provided for you at no cost and are nothing to be nervous about, however, you should be prepared.

Consultative exams are usually ordered when there is insufficient evidence in your Social Security disability application or the medical source you provided is somehow in question. In order to fully process your application and have DDS confirm your condition, one or more tests or exams may be necessary.