What Is Social Security Disability’s Consultative Exam (CE)?

March 14, 2018

After filing an application for either Social Security disability insurance (SSDI) or supplemental security income (SSI), some people will be asked to undergo a consultative examination (CE) before their application can continue through the process.

The CE is a step in the Social Security disability process that verifies whether an individual is medically impaired. It’s required in cases that do not present enough evidence up front about the patient’s condition to qualify him or her for benefits. In this way, it can be both a good sign and a cause for concern: it indicates your application hasn’t been denied, but you’re also not guaranteed approval.

What Happens During a Consultative Exam?

The wing of the Social Security Administration (SSA) that requests CEs is called the Disability Determination Bureau (DDB). These exams attempt to match the evidence provided by a patient more directly to the relevant illness or impairment being claimed in the application.

Depending on the type of evidence needed in the application, CEs can be long and involved processes. At the minimum, they require a physician to perform a standard physical examination in the relevant medical specialty, as well as gather a medical history and laboratory tests related to the patient’s application.

Once the doctor has gathered all the necessary evidence, he or she will compose a report with the positive and negative findings as they relate to the disability claim.

Other Types of Exams

For applications that list more than one impairment (especially those with both physical and mental impairments), the SSA may request a patient to undergo psychological tests or a psychiatric evaluation.

Even if the symptoms are mild, this test helps the DDB determine if your claim has potential mental implications in lieu of or in addition to evidence of other impairments listed in the application.

Who Performs Consultative Exams?

The DDB prefers to gather information during a CE from someone other than the patient’s treating doctor. Why? Typically, your treating doctor may not have the necessary equipment to verify the claim or may not be familiar with the CE process. Most applicants are sent to one of the DDB’s doctors for a CE instead of their own.

How a Consultative Exam Affects a Claim

The point of this process is not to provide a more accurate diagnosis, treatment plan, or prognosis to the patient, but to confirm or add to the evidence in the patient’s Social Security disability application. It is a tool the SSA uses to gather conclusive evidence to approve or deny the claim.

If the DDB notifies you that your CE has been scheduled, it’s important to follow up and actually attend. Otherwise, the SSA will make their decision based on the inconclusive evidence in your application, which will likely result in a denial.

Guidance from an Experienced Disability Attorney

If the request for a consultative examination has caused you anxiety, don’t be afraid. The doctor who will examine you should only be concerned with reporting evidence about your condition.

We know this process can be hard on patients who are struggling to get by without Social Security disability benefits. That’s why Hensley Legal Group’s attorneys work to strengthen applications, meet shifting deadlines, and handle communication for tired or frustrated SSD applicants. If you’re struggling with this complicated system, feel free to give us a call or contact us online for a free conversation about your claim.