Filing For Social Security Disability? Understanding The Effect Of Consultative Exams

If you've filed for Social Security disability benefits, not only will the person reviewing your claim look at your existing medical history, but also they'll often request consultative exams. These exams are scheduled with doctors who specialize in these assessments, not with your regular doctor. If your claims representative asks you to attend a consultative exam - physical, psychological, or both - there are a few things that you should know.

What Can You Expect?

During the consultative exam, you can expect to have to provide details of your medical history as well as specific information about the conditions or injuries that have led to your claim. In the case of a physical consultative exam, the doctor may do a physical evaluation, take x-rays, or order other tests. Psychological consultative exams often involve discussion about your past, meaning any experiences that may directly affect the psychological conditions you're struggling with.

How Important Is The Consultative Exam?

The consultative exam will play a key role in the evaluation of your application. However, if you have a primary care physician or a regular care provider, his or her records will be weighed more heavily than that of the consultative specialist. Both will be considered, but the more extensive records of your primary care physician will be viewed with more priority.

If either of your consultative exams feels dismissive or you don't feel that the doctor was inattentive, you should call your claims representative. He or she will hear you out and may schedule an additional exam if necessary. In addition, if you feel that your primary care physician is being dismissive of your concerns or doesn't have sufficient records of your claim, you can ask that the disability representative consider a consultative exam for more documentation. 

What If You're Denied?

If you complete a consultative exam and later have your claim denied, you may have the opportunity to appeal. Read the denial letter carefully to determine why the determination was made. Then, consider the things that your doctor has told you, the things that the consultative doctor told you, and what you reported to the disability claims representative. The denial letter should make it clear that they considered every condition addressed in your claim. If it doesn't, you can file an appeal on the grounds that they failed to consider something. Clearly state what you feel wasn't considered when you submit the appeal because your case will be reviewed by a different representative during that process.