Is a Consultative Exam a Good or Bad Sign for Your Disability Application?
December 14, 2022 · 4 min read
Did you just get a letter asking you to schedule a consultative exam in order to get disability benefits?
Consultative exams are a common source of stress for Social Security disability applicants, but they’re a regular part of the process. To help you make sense of your exam, we’ll break down what your exam says about your application.
What is an SSDI consultative exam?
A consultative exam (CE) is a medical appointment with a doctor who is contracted by the Social Security Administration (SSA).
Why would the SSA request a consultative exam?
The SSA requests a consultative exam if it feels the medical information from your application isn’t enough to make a decision. More specifically, your exam is set up by Disability Determinations Services (DDS), which helps the SSA with disability claims by handling the review of applicants’ medical evidence.
The letter that you received to schedule your exam should provide you with the reason for your exam.
Who pays for a consultative exam?
The SSA will pay for your exam, including significant travel costs, if required.
Is a consultative exam good or bad for your disability application?
If you need a consultative exam, the SSA believes that the medical information in your application isn’t enough to make a decision on approving your benefits. And since the exams are usually quick and not very thorough, they’re unlikely to result in new information that will help your case.
It’s very important that you don’t look at your consultative exam as your main source of medical evidence.
Your goal when applying should be to already have clear medical records of your disability. Then, the consultative exam will only be needed to confirm your claims, if it’s needed at all.
So why exactly do I need a consultative exam?
Consultative exams are needed when the SSA requires more information to make a decision on your application.
In some cases, the SSA doesn’t have enough proof that you have the condition you say you have. It’s also possible there are inconsistencies in your medical history or the SSA wants more detailed information about something.
Regardless, the disability doctor will likely ask about your functionality or how you handle certain daily activities. Specific tests — like blood work — may also be necessary to show you meet certain technical requirements for your condition.
Technically, consultative exams are not mandatory. You can refuse one, though refusing wouldn’t help your disability claim.
The SSA would have to rely on the information in your application, which they have already indicated isn’t enough for them to make a clear decision.
Instead of refusing the exam, you may want to schedule a visit with your personal doctor around the same time as your exam with the disability doctor. That way, if the consultative examiner finds that you don’t qualify for benefits, your doctor’s findings from the same time may help convince the SSA or a judge that you do qualify.
What to expect during your consultative exam
Consultative exams generally work like a basic physical or mental examination. Exactly what happens will depend on what information the SSA needs. (You can find the reason for your consultative exam in the letter that the SSA sent you to set up the exam.)
Consultative exam examples
For example, if your application says you have anemia, the SSA may request an exam where the doctor does blood work or checks for physical symptoms of anemia.
If you have back pain, you may meet with a physician who tests your mobility and asks questions about your pain to understand how severe it is.
If you’re applying with anxiety, your exam may involve a psychologist asking questions to help confirm whether you exhibit common symptoms of anxiety.
How long is a consultative exam?
It’s important to remember that these exams are usually quick — maybe 15 to 20 minutes — and not very thorough. They may feel awkward because you’re meeting a new doctor.
Don’t feel discouraged if the doctor doesn’t talk much or if you don’t connect with them in your short meeting.
How to answer questions during the consultative exam
You should follow the same basic guidelines at your consultative exam that you would for any doctor visit:
Be specific. Avoid vague answers or the doctor may assume you can do more than you can. Instead of saying you can’t stand for long, say you can stand for 10 to 15 minutes before you need to sit down.
Answer based on your worst or average days. When describing your symptoms and health conditions, describe how they affect you on average or even on your worst days — even if you feel good at the actual time of the exam.
Talk about your struggles. The exam is your chance to complain. The doctor needs to hear about how your disability affects your ability to work and handle daily activities. Be completely honest and make it clear that you’ve had to adjust your life because of your health condition.
After the consultative exam: What’s next?
The doctor who performs your consultative exam will complete a report with their findings and send it to the SSA to become part of your application file. You can also request that they send the results to your doctor.
Next, the SSA will make a decision to approve or deny your application based on the results of your exam and the rest of your file.
If you’re approved, congratulations! Your first check, which includes back pay, should arrive within 60 days.
If your application is denied, you can appeal the decision, at which point your odds of winning benefits are much higher if you have a disability lawyer to help you. They’re experienced in reading CE reports and know how to prepare you for your exam and how to challenge the CE doctor’s findings if necessary.
Can I get help with my disability application?
Yes, you can get help with your application — no matter what stage of the process you’re in — by hiring a disability lawyer.
A lawyer is an expert in Social Security disability benefits. They can give you personalized guidance on your application and help you build a strong case that the SSA is more likely to approve.
Many people who go through consultative exams have their applications denied — the SSA denies about 70% of all initial applications — but people who work with a lawyer are three times more likely to win benefits in the end.
If you’re not sure whether you’re ready for a lawyer, start with our 2-minute Social Security disability quiz. One of our team members will be in touch to learn more about your situation, and then they can match you with a lawyer if you want one.
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Jackie Jakab is Atticus’s Legal Director. She’s a licensed attorney, a graduate of the University of Chicago Law School, and has counseled thousands of people seeking disability benefits.
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