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The Process Of Benefit Applications For SSA Disability: Why Are You Being Sent For A Consultative Exam?

At some point in the process of filing for Social Security disability benefits, you may be told that you need to be seen by an independent medical examiner-a physician other than your own-in order for SSA to get enough information to make a decision on your case. This is called a consultative exam. Why is this happening and what does it mean for your case?

There isn't enough evidence in your file to make a clear decision.

A lot of times, the reason for the consultative exam is simply that there isn't enough information in your medical file for SSA to make a decision to either approve or deny you. You may have been without medical insurance-and therefore without anything but emergency services-for several years. If so, that creates a gap in your medical care that can only be resolved by having a current examination.

In most cases, however, the problem is one of these reasons:

  • Your doctor's notes are scarce or incomplete.
  • Your doctor's notes contain contradictory information or are unclear about the severity of your condition.
  • Your doctor didn't run some necessary tests to confirm your diagnosis, like MRIs, CAT scans, or bloodwork.
  • Your doctor didn't return the requested paperwork and medical records.

Surprisingly, a lot of disability claims are delayed or end up requiring a consultative examination simply because the doctor's office doesn't respond to requests for information in a timely manner (or at all).

You can take steps to avoid the need for a consultative examination.

The best way to avoid the need for a consultative examination is to have a quick conversation with your doctor to let him or her know that you're filing for disability. Ask him to make sure that his staff is on the lookout for records requests and maybe even get them ready in advance.

Most doctors don't really offer an opinion on whether or not you should file for disability. Except in rare cases, they usually leave that up to the patient because they're aware that only the patient can determine if he or she can continue working despite any impairments. However, some doctors are decidedly more supportive than others. If you get the feeling that your physician isn't supportive of your decision, it may be time to seek new medical care-before you actually file your claim.

For more information or assistance getting through the process of filing for disability benefits, contact us. We'd be glad to review your case.

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Shawn Taylor, PLLC
209 Capitol Street
Charleston, WV 25301

Phone: 304-932-4619
Fax: 304-414-6040
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