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What to Expect When Social Security Schedules You for a Medical Exam?

Posted Feb 01 2011 6:07pm

social security consultative examination Earlier this month I received an email asking about initial application procedures from a gentleman who had visited my Georgia disability web site.   This person had not yet applied and he wrote to ask me what he should expect when he did apply.

After discussing with him the ways he could apply – either by phone, in person at his local Social Security office, or online at ssa.gov, he asked me what was going to happen after he started his application.  I explained that once his claim was opened, his file would be sent to a disability adjudicator and that he should expect to hear from the adjudicator to set up an in-person or telephone interview.

Today, I heard back from this gentleman asking another very good question about the initial application process.  I believe that he has been through his initial interview and that his claim is now being processed.   Since his question is relevant to just about everyone who files for benefits, I thought I would answer it in my blog rather than by an email.

The applicant told me that he had applied in person and that his adjudicator had scheduled him to meet with a private doctor for a medical exam.  Is this a good sign or not?  What should he expect at this meeting?  Here are my thoughts:

The exam that has been scheduled is called a "consultative examination."   These examinations are conducted by doctors who have contracted with the Social Security Administration to do this kind of work for a designated fee.

The most common kinds of consultative evaluations are general physical exams, as well as mental health evaluations by psychologists.   Depending on where you live, there could be specialists (such as cardiologists, neuropsychologists, etc.) on the consultative examination panel.  Further, if your regular treating physician will handle a consultative evaluation for the payment offered, your doctor can also serve as the provider for this evaluation.

In my experience, physical consultative evaluations are usually a waste of time.  Often the doctors on the panel for physical exams are "industrial clinic" doctors who also perform independent medical examinations for insurance companies in workers' compensation cases.  More often than not, these clinic doctors will find nothing wrong with you.

By contrast, the psychologists who perform consultative psychological examinations will often identify one or more mental health issues.  These issues may not be "disabling" but they can pay dividends later by eliminating categories of jobs and thus narrowing the judge's questions to a vocational witness at your hearing.

My experience has been that most Social Security judges recognize the limitations of a one time consultative examination and they weigh the importance of the exam report accordingly.  I also find that some of the medical or mental health vendors do a poor job when completing their reports – as I have discussed at length on this blog, the main issue in any Social Security case relates to your capacity to work, and I read far too many consultative reports that do not discuss this threshold issue at all.

As far as preparing for a consultative examination, there is not much  you can do.  If you have x-rays, MRI reports or CT scan reports, bring them.  If you have supporting records from a treating doctor I would bring those as well.  If you don't have any of this documentation, that is fine as well.

At this initial and reconsideration appeal level, you are not going to win, generally, unless your condition meets a listing.  The consultative evaluations make up part of the puzzle for a judge's determination about your capacity to work but your treating doctor's records, reports and statements of opinion carry far more weight.

Post from: Social Security Disability Blog

What to Expect When Social Security Schedules You for a Medical Exam?

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