December 22, 2014

The Consultative Exam (CE): Part 1

I have been asked a few questions which relate to the Consultative Examination (CE), which is basically a doctor’s appointment sometimes scheduled on your behalf by the SSA if they feel that additional medical testing/evidence is required to help them render a decision in your case. In this and the following two posts, I will answer questions about the consultative exam and explain in further detail what you can expect at the CE.

Question:

If the medical records I submitted with my claim are determined to be inadequate to make a disability determination, is there a possibility that additional information would be requested by the SSA on my behalf?

Answer:

The answer to your question is ‘maybe.’ If additional medical information is requested and/or a clarification is needed, your original treating source (physician, specialist, psychiatrist, etc.) is the first preferred source to contact. However, there is a second option available, which is the scheduling of a consultative examination (commonly known as a CE) through an independent source.

Again, your treating source is the preferred choice for additional examinations as long as the following requirements are met:

  • Your treating source (physicians, specialist, psychiatrists, etc.) is qualified;
  • He/she has access to the testing equipment required to perform the examination and/or requested testing;
  • He/she is willing to perform the requested examination and/or tests for a set fee, established by the state in which you have made application in;
  • He/she is able to furnish a complete report within a specified time limit

However, as mentioned above, there are provisions that allow for an independent source, that person other than the treating source, to conduct a consultative examination and any future testing. Those instances in which an independent source would be considered over a treating source are as follows:

  • The treating source cannot or does not prefer to conduct the requested examination;
  • Conflicts and/or inconsistencies exist in the claimant’s file which are unable to be rectified by going back to the treating source;
  • The claimant prefers an independent source and presents a valid reason for doing so;
  • The treating source is considered an unproductive source

So, when the SSA determines it necessary to schedule a CE, they will contact the independent source, schedule the appointment, and then notify you of the appointment date and time.

The types of additional testing and/or examinations requested are strictly limited to the additional evidence needed in order to render a decision on the claimant’s application for disability. Tests conducted outside of the needed information requested are not permissible unless the examination warrants additional testing. In this event, the treating source must have prior approval before conducting further tests.

Please stay tuned for Part 2 and Part 3 of this mini-series on the consultative exam.

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Jonathan Ginsberg represents Social Security disability claimants in Georgia. In practice for over 23 years, Jonathan publishes a widely known disability blog, a podcast and several disability web sites. In 2004, Jonathan published a "how to" book about Social Security disability called the Disability Answer Guide. Jonathan lives with his wife and 2 children in Atlanta.

Comments

  1. patricia harrris says:

    I have a cartoid artery that is occluded of the brain and one neurosurgen says it was best to leave it alone and I want a second opinion and so does my family doctor at duke university is where my doctor wants to go well i have already applied for diability but now they want me to see a phd for further evaluation for my aniety and depression I have been working since 1989 and now where i work say i would be a liability if i work there because of my job description and could also have a major stroke so I can’t work until the place is fix . but my regular says to postpone the appointment until I see the director of neuroscience in durham can I postpone this appointment but not jeopardize my claim at this time

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