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What to Expect When Social Security Schedules You for a Medical Exam?

social security consultative examinationEarlier this month I received an email asking about initial application procedures from a gentleman who had visited my Georgia disability web site.   This person had not yet applied and he wrote to ask me what he should expect when he did apply.

After discussing with him the ways he could apply – either by phone, in person at his local Social Security office, or online at ssa.gov, he asked me what was going to happen after he started his application.  I explained that once his claim was opened, his file would be sent to a disability adjudicator and that he should expect to hear from the adjudicator to set up an in-person or telephone interview.

Today, I heard back from this gentleman asking another very good question about the initial application process.  I believe that he has been through his initial interview and that his claim is now being processed.   Since his question is relevant to just about everyone who files for benefits, I thought I would answer it in my blog rather than by an email.

The applicant told me that he had applied in person and that his adjudicator had scheduled him to meet with a private doctor for a medical exam.  Is this a good sign or not?  What should he expect at this meeting?  Here are my thoughts:

The exam that has been scheduled is called a “consultative examination.”   These examinations are conducted by doctors who have contracted with the Social Security Administration to do this kind of work for a designated fee. Continue reading →

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.

Onset Dates, Consultative Exams and Cynical Judges

When you appear before a Social Security judge for a hearing, there are four possible outcomes:

  1. you will be approved
  2. you will be denied
  3. your case will be continued to another date for a supplemental hearing
  4. the judge will issue a “partially favorable” decision

GavelOver the past couple of years I have noticed an increase in the number of partially favorable decisions I am receiving.  I think this is because my clients, especially low income clients, do not have access to regular medical care and judges are using consultative exam reports to move the alleged onset dates.

Here is an example of what I mean:  a couple of weeks ago, I tried a case before a judge who is generally considered to be very reluctant to approve cases.  At the time of the hearing my client was a month shy of her 52nd birthday.  She had a 10th grade education and past work as a short order cook.  She alleged disability due to uncontrolled diabetes, numbness in her feet and hands, vision issues and pain.

She last worked 3 years previously, when she was 48 years old.

In reviewing this case, I saw it as a “grid rule” case.   Grid rule 201.10 provides that a 50 year old claimant with less than a high school education, semi-skilled work but no transferable skills who was limited to sedentary work due to an exertional limitation would qualify for disability. Continue reading →

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