Consultative examiner said I was disabled. Why was I denied?
Consultative Examiner said I was disabled
Recently on our disability forum we had an applicant ask, Why if I was sent to a SSA doctor (consultative examiner) and told that I should get SSDI did I end up getting denied for benefits by the Social Security Administration? This blog will address why the SSA might send you to an examination and then deny your benefits even if the doctor suggests you are disabled.
When do you get sent to a consultative examiner for an SSA medical evaluation?
If you have applied for Social Security Disability Insurance (SSDI) the SSA will make a request for medical evidence from your treating sources. According to the SSA, they will request information to determine impairment severity and the individual's residual functional capacity. Additionally, they will consider all of the evidence in the individual's record to determine whether the individual is disabled. Ideally they would gather this information from your treating sources because your treating physicians have the best information about your medical condition.
What happens if they cannot get the information from your doctor? If the SSA decides they do not have enough information to make a disability determination a consultative examination is purchased, at Government expense, from the treating source whenever possible. Because basing a decision on evidence from a treating or other medical source is not always possible for various reasons, it is sometimes necessary to purchase a consultative examination (C.E.) from an independent source at Government expense.
What information is given by the consultative examiner (C.E.) to the SSA?
At the completion of the consultative examination the consultative examiner will be required to send specific information back to the SSA in a report. According to the SSA, the consultative examiner will send a report to the SSA which provides the following information:
- Provide evidence that serves as an adequate basis for disability decision making in terms of the impairment it assesses.
- Be internally consistent. Are all the diseases, impairments and complaints described in the history adequately assessed and reported in the clinical findings?
- Do the conclusions correlate the medical history, the clinical examination and laboratory tests, and explain all abnormalities?
- Be consistent with the other information available within the specialty of the examination requested.
- Did the report fail to mention an important or relevant complaint within that specialty that is noted in other evidence in the file (e.g., blindness in one eye, amputations, pain, alcoholism, depression)?
- Be adequate as compared to the standards set out in the course of a medical education.
- Be properly signed.
What if the SSA denies my case after a consultative examination?
The consultative examiner does not decide if a claimant is disabled or not. They will only provide evidence to the SSA about your condition and your limitations. It is up to the SSA to evaluate all of the information provided by the consultative examiner as well as your treating doctors, and decide if you are impaired according to their standards.
If you have been denied after the C.E. examination the SSA will send you a letter stating why your case was denied. It is up to you at that point to determine if you should appeal the denial. If you choose to appeal you have 60 days from the date of the denial letter to file a reconsideration.