Any time an individual is applying for Social Security Disability Insurance or Supplemental Security Income benefits, the Social Security Administration requires medical documentation in order to prove the disability. This medical documentation comes in the form of a medical evidence, records, treatment histories and statements from treating physicians. However, when this information does not provide the SSA with enough evidence, they SSA will also require a consultative exam. If a consultative exam is needed, the Social Security Administration will send out a letter informing the prospective beneficiary of the date, address and time of the examination.
Why is a consultative examination important? Because the exam may help with the approval of your Social Security Disability application – especially in cases where long-term medical evidence is not available.
The consultative exam may be necessary if an individual's physician has not responded to requests for information or records in a timely manner. It may also be necessary if your physician is not considered a specialist in the disabling medical condition for which you wish to receive benefits. While in most cases, the treating physician is considered the primary source of any information regarding a disability or medical condition, there are cases where an individual may be asked to see a physician designated by the Social Security Administration.
A consultative examination may also be required for individuals filing for workers compensation. This is done to verify the veracity and accuracy of the claim. In such cases, the consultative examination is necessary to continue with the processing and potential approval of the claim.
Neglecting to attend the consultative exam appointment may endanger the Social Security Disability application process. An individual who refuses or neglects to show up for a scheduled testing or examination date may find their claims denied for "failure to cooperate" or refusal to provide required documentation regarding their Social Security Disability claim.
In cases where the disability examiner or person in charge of your case questions psychological impairment, he or she may request the claimant engage in a mental examination as well as a physical examination.
In cases where the Social Security Administration selects a medical professional to perform the medical exam, that doctor will not treat the individual. The type of evaluation ordered and the scope of the evaluation is determined by the claim of disability. Individuals can be referred to psychiatrists, psychologists, or medical doctors for their consultative exams, but these doctors are only there to examine the condition of the patient, not to offer treatment or treatment advice.
The doctor assigned to perform the consultative exam examines the patient and prepares a report of his or her findings, which are then submitted to the Social Security Administration. The report, also called a Disability Determination Evaluation, is an important document that is considered by the Social Security Administration in their determination of whether the disability benefits will be awarded.
Consultative exams are determined on a case-by-case basis, and not every individual filing for SSDI is required to take one. For individuals with more than one health issue, doctors in specialty areas may be requested to offer reports. The Social Security Administration requests consultative exams based on certain factors, including when additional information is required, for clarification of laboratory tests, clinical findings, current medical evidence and for diagnosis and prognosis reports.