If you’re in the process of applying for disability, you may need to take a consultative exam to provide the Social Security Administration (SSA) with additional information about your condition. This exam helps the SSA make a decision on your application. But the exam can also be intimidating. It’s probably with a doctor you don’t know and SSA isn't unclear about how it affects your application.
Let’s break down what the consultative exam is and other information you need so it goes as smoothly as possible.
What is a consultative exam?
A consultative exam (CE) is a medical exam or test you’ll receive while applying for SSI or SSDI if your health records aren’t enough to prove your eligibility. The CE happens after you submit your disability application, though exact timing varies. What happens during your exam also varies. You may receive a general physical exam, a psychological evaluation, or only a specific test, like an X-ray.
The main purpose of a consultative exam is to determine whether your health condition meets the SSA’s definition of disability, so your experience will depend on your situation. Regardless, you only need a CE if SSA requests it and they’re usually short — less than 20 minutes long.
Does everyone need a consultative exam?
Not everyone who applies for Social Security disability will need a consultative exam but they are very common. You’ll know if you need one because Disability Determination Services (DDS) — which handles medical evaluations for the SSA — will send you a letter with instructions for setting up an appointment.
5 reasons you may need a consultative exam
When you apply for disability benefits, the SSA has the Disability Determination Services collect medical records from your personal doctors. DDS may request a consultative exam if your records don’t clearly show three things: that you have the health diagnoses you say you have, that you’ve actively sought treatment for those diagnoses, or that your condition meets the SSA definition for disability benefits.
Here are five common situations when you'll need a consultative exam:
Your health records don’t clearly show that a professional diagnosed you with the condition you say you have.
DDS needs more detailed information about the severity of your impairment.
There are inconsistencies in your medical history, like conflicting results from your doctors.
The information in your benefits application doesn’t clearly show that your condition keeps you from working.
Certain technical or specialized requirements aren’t addressed in your medical records, so DDS can't prove your condition meets the SSA definition of disability.
Need help improving your medical records? The best option is to work with a disability lawyer. They’re experts in the disability process and can advise you on the best way to strengthen your claim. Applicants with lawyers are also three times more likely to win benefits. Learn more about what disability lawyers can help you with.
Is a consultative exam a bad sign for my application?
The consultative exam isn’t necessarily a good or a bad sign for your disability claim. With that said, if you need a CE, it probably means your medical records aren’t enough for Social Security to make a decision on your application. Sometimes consultative exams are enough to answer lingering questions, but often it isn’t.
The CE should never be your sole source of medical records and you shouldn’t rely on it to win your claim. This exam isn’t usually the most thorough and it will be most helpful when it comes on top of records from your usual doctors.
Each exam differs based on your condition. In most cases, you will receive a basic physical or psychological exam. You might also need specific imaging or laboratory tests, such as an EKG, X-ray, or bloodwork.
During your exam, the disability examiner will only look at what the SSA has asked for. They won’t do anything extra and you won’t be able to ask them for tests that you think would help your claim.
Make sure that you’re completely honest about your condition and how you’re managing it. Tell the doctor what symptoms you’ve been experiencing and answer based on how you feel on your worst days – even if you feel good on that specific day.
After the exam is over, the doctor fills out a report with their findings. They send that report to DDS and Social Security. The CE report becomes part of the medical evidence in your claim file.
Lawyer tip: It may be a good idea to see your own doctor around the time of the consultative exam. If your disability claim is denied and you need to challenge the examiner’s findings, having more detailed results from your own doctor could help.
In most cases, your exam is performed by an independent doctor, physician, or psychologist who is contracted by the SSA.
However, the SSA prefers to ask your existing doctor to perform the exam. If you want your personal doctor to do the CE, you ask about that when you schedule the exam with DDS. It’s possible they already asked your doctor, who declined.
Why your doctor might not do the exam
A big challenge with having your own doctor conduct the exam is timing. They must be willing and able to quickly complete the required testing and send in a report with their findings. It might be easier to have your own doctor conduct the CE if the SSA is only requesting a certain kind of test instead of a full physical exam.
Another reason your doctor may not want to do the exam is that the SSA will pay a set fee and your doctor may normally charge more for that service. In that case, it may be possible for you to pay the difference between what the SSA offers and what your doctor will accept.
Who pays for the consultative exam?
Should you need a consultative exam, you won’t have to pay for it. The SSA will cover the cost. If you want an interpreter during the exam, that will also be provided for free (but make sure to request one when scheduling your exam).
Keep in mind that you do have to get yourself there, which may result in costs for gas or transportation.
What happens if I miss the consultative exam?
It’s important to make every effort to attend your CE. By asking for the exam, the SSA may feel they don’t have enough information to approve your disability claim. Missing the CE won’t help that.
If you do miss your exam, the SSA will make a decision based on the information they have from your application and your existing medical records.
You can reschedule your consultative exam in some cases but you’ll likely need a serious reason for missing it. Something like, “my child is sick today and I have to stay home with them,” may not be enough.
Where to get help with the consultative exam
If you have questions about the consultative exam, consider working with a disability lawyer. It may sound strange to get a lawyer involved, but they know the ins-and-outs of the disability process, so they can help increase your chance of winning benefits.
And if the results of your consultative exam are not enough and your claim is denied (the SSA denies three-quarters of initial applications) a good disability lawyer will know the best way to challenge the results and convince a judge of your eligibility during an appeal.
Atticus has a deep network of attorneys with years of experience helping people get Social Security disability. And if you’re not sure whether a lawyer is right for you, we’re a law firm so we can give you advice, for free, on whether a lawyer could actually help your claim. Start with our 2-minute disability quiz and we’ll reach out to learn more about your situation.
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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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