Have you recently received your mail and found a letter ordering you to undergo a consultative exam (CE) in the next couple of weeks? For many people, receiving a letter from their state’s Disability Determination Services (DDS) can be anxiety-provoking. Many applicants may mistakenly believe that the Social Security Administration (SSA) believes they are lying about their condition or that their own doctor cannot be trusted.
Understanding the nuances of the SSA’s request that you submit to a consultative exam can help you manage your stress and feel confident throughout the application process. The following article provides crucial information on what to expect and how to prepare for a CE.
What Is a Consultative Exam (CE)?
A consultative exam (CE) is a medical or psychological evaluation ordered and paid for by the SSA but ordered by your state’s Disability Determination Services (DDS). The DDS focuses on medical and vocational evaluations of your impairment when you have submitted a disability claim.
Why the SSA Requests a Consultative Exam
A CE can be ordered if the judge or government examiner evaluates your medical file and determines that it lacks sufficient evidence to make a definitive ruling as to whether you are disabled.
The three most common reasons that a CE is ordered include:
- Gaps in medical care: Gaps in care may result from you losing your health insurance or an inability to afford the costs to see specialists.
- Missing medical records: Your records do not include the objective medical evidence required by SSA regulations. Examples include updated diagnostic tests such as MRI, X-rays, range-of-motion metrics, or a blood panel.
- Lack of functional limitations: Your personal physicians provided diagnoses, but failed to state your functional limitations clearly. Examples may include how much weight you can lift or exactly how long you can stand.
Can a Consultative Exam Negatively Affect My SSDI Claim?
Although a consultative exam is a fairly routine request from the SSA when processing SSDI claims to fill in medical records gaps, it can damage your case. Depending on the CE results, the government may use the report as evidence to deny SSDI benefits.
The Key Risks of a Consultative Exam (SSDI)
- The One-Time Exam Trap: A CE is usually a very brief visit with the doctor who conducts the exam. Suppose you are having a good day, relatively free of pain, or try to push through the exam to show your cooperation. The doctor may document that you can move without restriction, leading SSA to believe this is a daily occurrence.
- Lack of Expert Medical Insight: Contrary to what some people believe, the doctor who conducts your CE exam for SSDI is most likely not a specialist. If you have a complex medical condition, they may not be qualified to write a report that accurately reflects your current health issues.
- Overriding Your Long-Term Doctor: The SSA no longer gives automatic preference to your treating physician’s opinion for any claims filed after March 2017. Currently, medical opinions are evaluated based on consistency and supportability. For example, suppose the CE doctor writes a report stating that you can perform non-strenuous work. The SSA could use the exam doctor’s report to override the years of treatment notes provided by your personal physician.
How Do I Prepare for a CE?
Preparing for a CE can help you feel confident during the appointment. Being prepared can make the difference, as a poor CE review can damage your case.
Begin Preparing the Night Before
You should begin your preparation the night before, keeping in mind that the exam is not like a regular doctor’s appointment. Take time to write out a list of your current medications and gather all copies of your test results so that you can turn them in, just in case your file did not make it to the doctor’s office. You should also be ready to explain your daily routine.
Keep in Mind that the Unseen Evaluation Begins in the Parking Lot and Waiting Room
Many applicants are unaware that the evaluation begins the moment their vehicle arrives in the parking lot. The doctor or office staff may be looking out the window to observe how you get out of the car and walk across the parking lot.
You should also be aware of your behavior. Suppose you have a medical condition that affects your ability to sit for long periods. Be sure to stand up and stretch to relieve pressure. You must also be mindful of any questions the medical staff asks, as simply saying you are doing okay could be used against you.
Inside the Exam Room
The CE will last only a few minutes but can have far-reaching consequences. If the doctor asks you to complete a task such as touching your toes, stop moving at the exact moment you begin to feel pain. You should also avoid giving vague answers when asked questions about your condition, such as, “My back hurts.” Instead, give thorough answers such as “I feel a shooting pain in my lower back when I try to stand longer than 15 minutes.” Do not try to exaggerate or minimize your condition, as doctors are trained to detect inconsistencies. If you are being evaluated for a mental health condition, do not try to portray that everything is fine. Instead, be sure to provide accurate details of your worst days, such as feeling depressed or dealing with crippling anxiety.
Don't Let an SSA Denial Cost You Your Future, Contact Liner Legal Now
If you are facing a disability medical exam, you may be feeling overwhelmed and unsure of how to protect yourself. Liner Legal has highly experienced Social Security disability lawyers serving clients nationwide. If you have questions or concerns about an upcoming consultative exam, contact us today to book a free consultation with our lawyers to determine your legal options.