SSA scheduled a consultative examination for me…now what?

SSDI Application Process | Help with Social Security Disability | LaBovick Law Group of West Palm Beach, Florida

When submitting a claim for social security disability benefits, the Social Security Administration will review your claim to determine if you meet the definition of disability, as defined in the code of federal regulations. While there are several criteria to be reviewed when evaluating a disability claim, the most important determination is made regarding your medical situation. Specifically, what medical conditions do you suffer from and how do they impact your ability to work. When making this determination social security will review not only your medical records but also obtain statements from you regarding your situation, as well as potentially scheduling you for a medical evaluation to be performed by a medical doctor. So, if you have applied for disability benefits, do not be surprised when social security requests copies all of your most recent medical records, asks you to fill out questionnaires, and schedules you for a complete medical examination, called a consultative examination.

Consultative examinations are an important aspect of your claim for disability benefits. They are not required but can certainly be a deciding factor as to whether your claim is approved or denied. Deciding whether to attend or not attend a consultative examination can be used as a strategy to strengthen your claim. In some cases, you may want to attend this evaluation, in other situations, it is best not to attend the appointment. In either instance, having an experienced disability attorney to guide you through the process is of the utmost importance. You do not have a choice in submitting a complete medical history to the social security administration. There is a regulation directly on point making it a requirement to provide social security all of your medical records for the relevant time frame. So, your medical history is not disputable. But attending a consultative examination with a medical provider that is supposedly independent but paid by the administration is a strategic decision that you and your disability attorney need to make.

Let me back up a minute and explain just what exactly a consultative examination is. This examination, which can be either physical or mental, is a medical exam requested by the social security administration to provide more information and context regarding your claim for disability benefits. This generally means social security is saying your medical records alone are not enough proof to find you either disabled or not disabled. That means your claim alone could hinge on this examination performed by a doctor hired by the social security administration that does not know your full medical history and spends a very short period of time with you. Again, this exam could be a good thing or a bad thing in terms of your claim being approved. It needs to be used as part of your winning strategy. For example, if the doctor you are scheduled to have an examination with is notorious for submitting no limitations you would not want to attend that evaluation. You may say that is way too extreme of an example, but I promise you it is not. I have seen several doctors that routinely “perform” these examinations who neither take the time to actually evaluate the claimant nor write down any limitations. Tell me exactly how someone who has undergone a stroke paralyzing their whole left side has no limitations whatsoever. Or someone who has had their leg amputated above the knee has absolutely no limitations. It happens so knowing who the doctor is that is performing the examination is an important thing to know when deciding to attend the appointment.

Now if you elect not to attend your appointment you can be fairly certain your claim will be denied. Again, that may be part of the longer strategy for your claim. If you know the doctor is not likely to be favorable, then why participate in an examination so that the doctor now submits evidence that is damaging to your claim? You are going to be denied anyway. A better strategy would be to avoid the exam and appeal the denial to the next stage in the process.

Of course, not every consultative examination that is scheduled is a bad thing. There are a lot of claims for disability benefits where the individual lacks health insurance so as to build of their treatment notes. In that situation, an examination would be vitally important for your claim to be approved.

There are a few things you can do to help frame a positive outcome of a scheduled consultative examination. First and foremost, you need to be represented by an experienced disability attorney…as we have already covered above. The second thing to do is during the examination to make sure to be honest with the doctor but do not overshare. When describing your symptoms describe them as if you are having a bad day. This is specifically important to medical conditions that cause good and bad days during the week. For example, people who suffer from depression generally have ups and downs, days that are better than others. Make sure when you are describing your depression that you describe it from the standpoint of a bad day, not a good one.

A third thing you can do to help get a positive outcome of the exam is to bring in copies of your medical records. Sometimes social security will send your medical records to the doctor to review prior to the appointment, but more than often they do not. Or the doctor will only receive a few treatment notes, rather than your whole medical file. In any event, bringing a copy of your full medical record for the doctor to review will help bring that medical provider up to speed on your situation. And the fourth thing you can do is after your examination, write a short summary about exactly what happened during the appointment, who actually examined you, how long the examination took, how long you waited prior to the examination, and what the medical provider had you do during the examination. Your description after the examination may prove vitally important in determining the weight that piece of evidence should be afforded in your claim for disability benefits.

If you have been scheduled for a consultative examination regarding your disability claim, call us at the LaBovick Law Group. We love it when our clients are scheduled for a consultative examination as this helps our strategical attack on winning you benefits. Call us today at (561) 625-8400 for your free consultation.

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