What is a Consultative Examination and what is in a Consultative Report?

Many Social Security Disability claimants want to know if the Social Security Administration has asked them to see a Consultative Examiner, what this means for their Social Security Disability Insurance or Supplemental Security Income Case.

If the Social Security Administration has requested that you see a C.E. or consultative examiner this means they do not have enough medical evidence (from the medical sources you provided) to prove that you are disabled, and they need additional information to make either the Social Security Disability Insurance or Supplemental Security Income disability determination.

According to the Social Security Administration, the claimant’s treating physician can provide the consultative examination if they are “qualified, equipped and willing to perform the additional examination or tests for the fee schedule payment and generally furnishes complete and timely reports.”

What if the primary doctor is not willing to perform the consultative examination? The Social Security Administration will use an independent source if the following conditions are met:

• The treating doctor does not want to do the consultative examination.
• There are conflicts or inconsistencies in the file that cannot be resolved
by going back to the treating source
• The claimant prefers another doctor to review their case and they good reason for their preference
• The SSA determines the treating source may not be a “productive source”

What type of tests can the consultative examiner request? It will depend on the type of additional evidence needed by the Social Security Administration to make their disability decision. Prior to completing any additional testing (such as X-ray, PFS or EKG), the medical source should contact the Disability Determination Services office and request approval.

How does the Social Security Administration select a Consultative Examination Source?

The Disability Determination Services office must purchase consultative examinations from “qualified medical sources.” As mentioned before, this can include the claimant’s treating physician or psychologist.

The consultative examiner must be “qualified”, which the SSA defines as a “currently licensed in the State and have the training and experience to perform the type of examination that they request.”

The consultative examiner must also have a good understanding of the Social Security Administration’s procedures and processes, they must understand how the SSA makes their disability determination, and they must be willing to provide the evidence and reports requested by the SSA.

How does the Social Security Administration choose who will perform the consultative examination? The Social Security Administration will make their decision based on what C.E. is available, how far the office is from the claimant and whether or not the C.E. can perform the exam and tests required by the SSA.

What is a Consultative Examination Report?

The Social Security Administration has established reporting procedures which each consultative examiner should follow. Reports should include the claimant’s claim number and a physical description of the claimant.

What is the purpose of the report? The Disability Determination Services examiner must be able to read the report and understand the nature, the duration, and the severity of the claimant’s health condition. If the claimant is an adult, the SSA should be able to determine if the worker’s condition allows them to continue to perform basic work functions.

The DDS is also validating that the report is consistent and all of the diseases, the physical and mental health impairments and the claimant’s complaints, which they outlined in their application, are adequately addressed and reported.

The DDS will also ensure that the C.E. report does not fail to mention other pieces of information and complaints that were evidenced in the claimant’s SSD file.
What does the report NOT include? The report, according to the SSA, should not include the consultative examiner’s opinion about whether or not the claimant is disabled, according to the definition outlined by the Social Security Administration.

Hiring a Social Security Disability Lawyer

If you would like a Social Security Disability attorney to review your Social Security Disability claim you can fill out the FREE evaluation form and a disability advocate will call you to review your claim or you can call our office at 1-800-641-3759 to talk to someone now.

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beth

Beth L. is a content writer for Disability Benefits Home. Good content and information is one of many methods we utilize to bring you the answers you need.
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