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 claimants 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 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 Administrations 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?
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 claimants health condition. If the claimant is an adult, the SSA should be able to determine if the workers 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 claimants 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 claimants SSD file.
What does the report NOT include? The report, according to the SSA, should not include the consultative examiners opinion about whether or not the claimant is disabled, according to the definition outlined by the Social Security Administration.