Understanding the Social Security Disability Consultative Exam

Do you have a medical condition that affects your ability to work? You could be eligible to receive Social Security disability benefits. When you apply for disability benefits, the Social Security Administration (SSA) will check your medical records to determine if your condition meets their criteria for receiving them.

Sometimes the SSA will require an applicant to have a consultative exam so they can finish processing their application.

What is a Consultative Exam?

A consultative exam is a medical examination. But, the consultative exam is not for the purpose of providing medical treatment. Instead, it is conducted so SSA officials can get an understanding of an applicant’s medical condition and the limitations it causes.

The SSA will first look at the applicant’s own medical records to gain this understanding. But, sometimes, the SSA may find the medical records insufficient and request the applicant has a consultative exam. The following problems with medical records could lead to the request for a consultative exam:

  • the applicant has not seen a medical provider for an extended amount of time
  • the medical provider has not responded to the request for medical records
  • the medical provider did not thoroughly document the applicant’s claimed medical condition
  • the SSA is not confident in the medical provider’s diagnosis and treatments 
  • there is an inconsistency in the medical records provided
  • the applicant’s condition is one that requires subjective standards of diagnosis instead of empirical measurements, so the SSA needs a confirming diagnosis

The applicant’s primary medical provider may do the consultative exam if the SSA approves them to do it. If the SSA does not approve, then they will arrange for a third-party medical provider to conduct the consultative exam. These medical providers are not employees of the SSA. They are independent contractors who the SSA pays to provide impartial medical reviews. The SSA pays for all consultative exams regardless of which medical provider performs it.

A consultative exam can consist of a physical or psychological examination. The exam may include extra tests such as blood work, x-rays, CAT scans, or EKGs. The extent of the examination and tests conducted depends upon what medical information the SSA is requesting. The SSA will outline the requirements for the consultative exam and what the medical provider must include in their report.

How to Prepare for the Consultative Exam

If the SSA requires you to have a consultative exam, you need to make your best effort to go to the appointment on time. If you cannot make the appointment, try to reschedule as soon as possible.

It will help your case if you go to the consultative exam prepared to answer the medical provider’s questions. You should prepare a list of your medical condition(s) and treatments you have and are taking for it.

You should also list how your symptoms impact your ability to do both normal daily activities and the requirements of your job. Do not exaggerate your symptoms. Give adequate details about the difficulties your condition causes you and your daily life and at work. It may be helpful to keep a daily journal of how your condition affects you.

When at the consultative exam, answer all the medical provider’s questions honestly and perform any requested actions to the best of your ability. You should not exaggerate your limitations. But, be sure to inform the medical provider of any pain or discomfort your experience during the exam.

Getting Help Filing Your Disability Claim

You can for Social Security disability on your own. But, due to complex issues such as the consultative exam, it may be best if you get the help of an experienced disability attorney.

First, a disability attorney will know if the SSA has substantiated reasons to require you to have a consultative exam. If so, a disability attorney will know what is expected during the examination based on your condition and can help you provide the examining medical provider the best information about your condition to ensure your best chance of getting benefits.

Brock & Stout’s disability attorneys have over 20 years of experience helping clients get the disability benefits they need. Contact us for a free evaluation to see if we can help you.