What is a Consultative Examination for Social Security?

By Michelle Shvarts
Principal Attorney

If you have applied for disability benefits through the Social Security Administration, you may receive a notice to appear for a consultative exam (CE). This is fairly routine and no cause for panic. The SSA may require a CE if there is a lack of medical evidence currently in your file to support your disability claim. Alternatively, a CE may be required if your treating physician has not responded to requests made by the SSA for more information or has failed to adequately document your health status. Regardless of the reason, complying with the CE request made by the SSA is an important part of the claims process. Let’s talk more about what the consultative exam involves.

What is a Consultative Examination for Social Security?

A consultative exam is different from other medical examinations you may have undergone in the past. The purpose of the CE is not to provide insight into the right course of medical treatment or to provide medical advice. Instead, the purpose of the CE is limited to simply assessing the state of your medical condition and the limitations that come with your condition. To learn more about what will actually go on at a CE and what will be included in the CE report, you can look to the SSA outline regarding CE requirements. Reviewing this information can be helpful if you have been summoned by the SSA to comply with a CE.

A CE may be physical or psychological, depending on your claimed disability. You should also note that there may be additional testing or lab work required by the CE. The CE may involve additional tests involving blood work and radiographic studies such as x-rays and also EKGs.

It is common for a CE to be performed by the benefit applicant’s own medical provider. The SSA will even offer to pay your provider for the CE service in most instances. Your medical provider must, of course, be both qualified and willing to perform the exam for the fee prescribed by the SSA guidelines. If it is the case that the medical documentation provided by your medical provider has been lacking, the Disability Determination Services office associated with the SSA may opt to schedule the CE with an independent medical professional. These are people who are not employed by the SSA but do receive payment from the SSA for services rendered. They are also required to submit a comprehensive report in the prescribed format following the exam.

Your CE will be scheduled at an office as close to your home as possible. DDS will schedule the exam and cover the costs associated with it. Complying with a CE request made by the SSA means that, if you want to obtain disability benefits, you will need to attend the CE. Missing the scheduled CD appointment means that the decision on your benefits application will be made based on the current status of your file. Failure to attend the CE will usually result in the denial of benefits.

Los Angeles Disability Attorney

Do you have more questions about a Consultative Exam notice or about the disability benefits application process in general? You can turn to Disability Advocates for answers. Contact us today.

About the Author
Ms. Shvarts is the managing attorney for Disability Advocates Group. She opened Disability Advocates Group to assist individuals who became disabled and unable to work to obtain the benefits they need and deserve.  Ms. Shvarts and the rest of the team at Disability Advocates Group are dedicated to assisting individuals obtain Social Security Disability Benefits (SSDI) and Supplemental Security Income (SSI) benefits.