Substituting Your Doctor for a Consultative Examination

The first thing to know and understand is that Social Security prefers having the applicant’s treating physician or healthcare provider perform the consultative examination.  If they want to use some other source, someone other than your own doctor, for to conduct the consultative examination they may have some very specific reason for making that requirement.  The best thing to do is to ask them to explain the reason that they are refusing to allow your own physician, a treating physician, from conducting the examination.  If there is a valid reason for the requirement Social Security will let you know at that point and you can follow their recommendations or make a formal written objection to their request. 

If the Treating Physician isn’t Enough

If Social Security insists on a requirement that you submit to a consultation examination with some other physician or healthcare provider than your usual treating physician, they will pay the travel expenses to access this person for examination purposes related to your disability determination application for benefits.  If you refuse to be examined by either your own treating physician or a Social Security designated healthcare provider, Social Security will simply make a determination based on the medical evidence currently in the file. 

Reasons Social Security may Require a Consultative Examination

• To gather more evidence because the evidence obtained is not enough to make a disability determination
• To obtain more detailed medical findings about the claimed impairment(s)
• To obtain technical or specialized medical information;
• To resolve conflicts or differences in medical findings in the evidence already in file
• To resolve the issue of your ability to do substantial gainful activity, if claimant is an adult
• To resolve the issue of the ability of a child under age 18 to function like other children his same age who do not have impairments.

Getting Legal Help

If you or a member of your family has been instructed by a Social Security administration program to appear for a consultative examination by a healthcare provider in connection with a claim for benefits based on a disability and you are fearful of the process and don’t understand how to proceed it may be helpful to contact a disability lawyer to discuss your application for benefits and the circumstance of your disability claim.  An attorney can provide valuable guidance on how to respond to the request of a consultative examination and help to ease worries about examination request and in office procedure.