When a Consultative Examination is Required

In addition to the medical evidence already submitted, the Social Security disability determination service may require a consultative examination to assist in making a final determination concerning an applicant’s claimed disability.  If ordered, a consultative examination is provided at the expense of the Social Security and costs the applicant nothing but his time.

Reasons for a Consultative Examination

Social Security may require a consultative examination for the following reasons:

• To obtain more detailed medical findings about the applicant's impairment(s)
• To obtain additional technical or specialized medical information;
• To gather more evidence because the evidence obtained is not enough to make a disability determination
• To resolve conflicts or differences found in the submitted medical findings

The extra examination is intended to resolve any issues as to an applicant's ability to work or do substantial gainful activity, if an adult; or, if the applicant is a child under age 18, to further assess his ability to function like other children his age without impairments.

Consultation Logistics

The consultative examination may be performed by the applicant’s usual treating healthcare provider. However, in certain situations the Social Security may require that the examination be performed by someone other than the “treating physician” for evaluation purposes.  The Social Security will also pay for any travel expenses required to appear at the office of a designated consultant examiner if necessary to make a final determination as the applicant’s claim. Finally, if the applicant outright refuses to become involved with a consultative examination the Social Security disability determination service will then simply revert to making a final determination as to the applicant’s claim by reviewing only the evidence before it as currently in the file or “on the record.”  The risk that an applicant takes in that instance is that without the additional medical information or assessment the disability determination service will likely enter a denial of benefits.  The disability determination service is requesting more information because impliedly because there is currently not enough information to award the requested benefits. The consultative examination is not a penalty but a last chance to “get it right” before a denial of benefits.

 Getting Legal Help

If you or a member of your family has submitted an application for benefits with the Social Security administration and has received a notice requiring a consultative examination prior to the making of a final determination as to awarding benefits for a claimed disability if may be helpful to contact a disability attorney to discuss the circumstances of the consultative examination.