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Why You Might Need a Consultative Examination

January 24, 2022 Disability

The Social Security Administration (SSA) requires extensive medical documentation to establish the existence of a disability. The agency uses a very strict definition of “disability” that is much narrower than the common meaning of the term, and only claimants whose conditions meet those listed in the Blue Book will qualify under the standard application process. It can often be difficult for Social Security disability claimants to produce such evidence; if that is the case, the SSA may order the claimant to undergo a consultative examination. If you have been notified that you will need to submit to a consultative examination, you may want to speak to a Baltimore disability attorney beforehand. 

What Is a Consultative Examination? 

Most claimants for Social Security disability benefits already have medical evidence documenting their condition. However, in some cases that evidence is not enough for the SSA to make a determination, especially if the evidence is silent or ambiguous on the issue of whether the claimant’s condition prevents him or her from working. If the SSA needs more medical evidence to establish a claimant’s eligibility for benefits, it will order the claimant to submit to an additional medical exam (the consultative exam) at the SSA’s expense. A consultative examination is not a comprehensive medical examination; the purpose of the consultative examination is to obtain the specific evidence the SSA needs through diagnostic tests. The doctor performing the consultative examination will not offer his or her opinion as to whether the claimant should receive benefits. 

Why the SSA May Order a Consultative Examination

The SSA orders consultative examinations when it needs to resolve inconsistencies in the claimant’s existing medical files or if the existing evidence is insufficient to allow the SSA to make a determination on the claim. This can occur when: 

  • The evidence needed is not apparent from the claimant’s medical records
  • The claimant cannot obtain the needed evidence for reasons beyond his or her control
  • The evidence needed is highly technical or specialized and cannot be obtained from the claimant’s treating physician 
  • There has been a change in the claimant’s condition during the application process that is likely to affect his or her ability to work, but the existing evidence does not address it

The doctor who performs the consultative examination may be either the claimant’s treating physician (if he or she has the skills) or a different doctor of the SSA’s choosing.

Is it Mandatory to Undergo Consultative Examinations? 

While not every claimant will need to undergo a consultative examination, if the SSA orders one, you must undergo it. Missing a consultative examination without a good reason can be grounds for the SSA to deny your claim. Acceptable reasons for failing to appear at a consultation include illness on the scheduled date, not receiving timely notice of the examination, and a death or illness in your immediate family. 

Contact a Baltimore Disability Attorney for More Information 

If you have been ordered to undergo a consultative examination and have questions about what it will entail, please contact Baltimore disability attorney Emmett B. Irwin by calling 443-839-0818 or using our online contact form.