Consultative examinations in the Social Security disability process: a bump in the road

For many claimants of Social Security disability benefits the process can be a long and windy road, full of bumps and bruises. One of those bumps along the way is often the consultative examination. Many claims are denied after the consultative examination, even though 75% of them go on to actually be awarded benefits later in the process. Let’s look at this stage of the process so that we can explain how to approach it and make the best of it,

Why are you given a consultative examination?

The Social Security Administration (SSA) office in charge of your claim will rely on your medical records and the opinions of your doctors when making a decision as to whether or not you are disabled. However, oftentimes the medical records are unclear or incomplete.  Sometimes the medical facilities did not properly transfer your records; perhaps your doctor is not a specialist in the field in which he diagnosed you. For a number of reasons the SSA will often schedule you to meet with one of their doctors for a consultative examination in order for them to gain the necessary medical information.

Types of consultative examinations

There are two types of consultative examinations: physical and mental. The differences between them are fairly obvious. Depending on the nature of your disability you may be assigned one or the other or both.

Client complaints about consultative examinations

Clients oftentimes are amazed at the briefness and incomplete nature of these examinations. They are usually brief and conducted with less than a tender and caring hand. It is certainly not the level of treatment you would get at your regular family doctor. The reasons for this are varied. The doctor could be overworked and may have many patients to see. Whatever the reasons, be aware that clients often have more complaints about this part of the process than any other.

What does the SSA do with the consultative examination report?

If the doctor concludes that the disability is in line with one of the listings then they will label you as disabled, will relay their opinion to your local office and they will grant you benefits. However, more likely the doctor will conclude that you are not in line with one of the disability listings. If this is the case you will be denied your benefits and you will have to begin the appeals process. Keep in mind though that a majority of claims are denied at this level and many of them go through the appeals process only to be approved in the end.

The problems with the consultative exam

Few will tell you this, and even fewer would admit to it, but the system is rigged against the claimant. Doctors are hired on renewable contracts with the SSA and if they approve everyone who walks through the door then it is very probable that they would not last very long. They are incentivized to deny everyone but the worst. It is an unfortunate reality, but a reality nonetheless. But being aware of it can help you to prepare yourself mentally for a longer process to get your benefits.[1]

[1] Berkley, Benjamin H., Win Your Social Security Disability Case, (Sphinx Legal, 2008)