What do social security doctors look for?

When you apply for Disability benefits, the Social Security Administration (SSA) reviews your application documents to determine if you provided sufficient information about your medical condition. In some cases, the SSA may request a consultative examination with the Social Security doctors to get more insights into your medical condition.

If you have a consultative examination appointment with a Social Security doctor, the doctor will conduct a physical examination that may include checking your blood pressure, heart rate, blood work, X-rays, and/or mental evaluation. The doctor may also examine the specific body part that is affected by the medical condition. In some cases, the doctor may perform extensive tests ordered by the SSA depending on the nature of the disability.

What is a consultative examination?

A consultative examination is a follow-up medical procedure after you have submitted a claim for Social Security Disability Benefits. This procedure may be necessary when the information submitted in the disability claim is not consistent or you did not provide enough medical evidence to justify your disability. Also, if there is a change in your medical condition, a consultative examination with a disability doctor can provide further insights into your condition. The SSA bears the cost of the examination.

During the consultative examination, the disability doctor will review your medical history, ask questions about the extent of your medical condition, and conduct any tests that the SSA ordered. The goal of the examination is to review your current medical condition to know the severity of the condition, and how it prevents you from doing everyday activities.

Who conducts a consultative examination?

If your regular physician has the required skills and equipment to carry out the examination, he or she can be the consulting doctor to perform the test, but they have the option of opting out. If this happens, the SSA will require an independent medical provider to carry out the examination and offer an unbiased opinion about your condition.

Generally, the consulting doctor is selected based on their availability, proximity to your location, and their qualifications to enable them to perform the required exams. The SSA may also require eligible consulting doctors to have an understanding of the SSA disability programs. The consulting doctor must be a licensed physician in private practice, or working under the supervision of a licensed doctor.

What if you don't like the consulting doctor?

If the SSA sets up the consultative examination and you are assigned a doctor you have had a bad relationship with, you may want to have the consulting doctor changed. Typically, the SSA may allow the consulting doctor to be switched to a different doctor upon request, but you must provide a valid reason to support the request. 

For example, if the assigned doctor has previously performed an examination that resulted in a denial of your disability claims, the SSA may approve the consulting doctor change.

What does a consultative examination entail?

The medical examiner is required to gather final evidence regarding your medical condition to support or deny your disability claim. A complete consultative examination involves all elements of a physical examination, which may include examining your blood pressure, heart rate, blood work, X-ray, mental evaluation, and other routine checks.

If the disability affects a specific part of the body, the examination may evaluate the impaired part(s) of the body and perform the specific tests ordered by the SSA. The exams are usually brief, and the doctor will focus on the severity of the medical condition and its limitations. However, if there are extensive tests ordered by the SSA, the medical examination can last longer.

If you are claiming disability benefits due to a mental impairment such as bipolar disorder or depression, you may be required to undergo a mental status examination. During this examination, the psychiatrist will test your memory, judgment, intelligence, and your ability to follow instructions. In some instances, the psychiatrist may require you to take an IQ test.

What happens after the consultative exam?

Once the medical examiner completes the medical examination, he/she will write a consultative exam report that details the findings of the examination. This report provides information about your medical history, test results, lab results, and a diagnosis for the claimant. The report will also detail some of your physical characteristics to ensure you are the correct person, your punctuality, and whether you gave your best effort during the examination.

The consulting doctor will also include a write-up on whether, under the guidance of law, you are disabled, and what you are capable of doing despite the medical condition. The examiner’s opinion may focus on your ability to walk, stand, hear, speak, lift or carry objects.

Once the consultative examination report is submitted to the SSA, Social Security will review the report to make a final determination on whether you qualify for disability benefits. Typically, it can take a few weeks to receive communication from the SSA on whether your application was approved or rejected.

Do you have to go to a consultative examination?

When the SSA orders a consultative examination appointment, it means that it requires more evidence to support your medical condition, and failing to honor the appointment may result in the SSA denying your disability claim.

If you are far away from your home, and it is difficult to honor the appointment, you can call the adjudicator who set up the consultative examination and request a different doctor who is closer to your location. However, pushing the appointment forward could delay the approval process further, meaning you will be forced to wait longer for the benefits to be approved.

What should you do when meeting the Social Security doctor?

If you have a scheduled consultative examination appointment with a Social Security doctor, you should prepare for the exam to ensure it goes on smoothly.

During the exam, you should provide accurate information about your medical condition. You should be truthful, and avoid exaggerating your condition or symptoms. If the doctor thinks you are not being truthful, he/she can doubt your credibility.

Also, you should ask relevant questions about your condition such as your chances of improvement, and the type of treatments that are most successful in patients with a similar medical condition.