What is A Consultative Examination?

When you file for disability, the claimant bears the burden to prove the allegation that he or she is not able to work due a physical and/or mental impairment. Therefore, it is important to be in regular treatment to have proof that you are disabled. However, many people may not be able to afford regular medical treatment for lack of personal finances and insurance.

When the medical evidence available is not enough to make a decision in your claim, SSA may send you to a consultative examination (CE). You will receive a notice in the mail of the date, time, and location of your exam. If you are not able to attend, then you should contact the number listed in the notice to re-schedule the examination. You should co-operate and attend this examination and participate in these exams in good faith. If you fail to attend a consultative examination that has been scheduled for you, SSA may deny your claim for failure to cooperate.

Consultative exams can be done by your treating doctor (if he or she is qualified to perform the exam and they are willing to do so) or by an independent doctor who is contracted by SSA. Most often, the examinations are performed by contractors, who are not employees of the federal government but instead are paid to conduct the exam. The purpose of the examination is to evaluate your physical or mental condition; the examiner is not forming a treating relationship with you as a patient. Because the examination is not for the purpose of treatment, they are often short in duration. The examiner will perform either a physical or mental examination. Sometimes, an examiner may also take x-rays, perform pulmonary function tests, or IQ testing; they do not typically involve blood or urine testing. The government pays for this examination. Unfortunately, the government will not pay for more costly tests, such as CT scans or MRIs.

After the examination, the examiner prepares a written report for SSA. You or your attorney if you are represented may request a copy of the report. CEs can occur prior to your hearing or afterwards if the Judge believes additional evidence is necessary. These results of the examinations are not often clear cut; therefore, to be best prepared it makes sense to be represented by an attorney who would present additional arguments and evidence in your claim.