When you apply for Social Security Disability benefits, your application could go any number of ways. It’s shocking how many people are denied benefits on the first attempt. The Social Security Administration (SSA) is strict with applications in an effort to avoid fraudulent claims, but this leads them to be overzealous and many eligible people who desperately need these benefits are denied.
Other times, applicants get a letter from the SSA not outright denying their claim but informing them that they are scheduled to take a Consultative Exam, which can be scary and confusing. Most people don’t even know what a Consultative Exam is, what medical professionals they’ll be seeing, what’s involved, and what effect it will have on their claim.
Let’s break down the elements of a Consultative Exam, or CE. We’ll explore what it is, what’s involved, why the SSA may require a CE exam, and what effect it will have on your application. Finally, we’ll look at what you can do to challenge such a denial and where you can go to find the legal help you need.
What is a CE Exam?
A Consultative Exam, or CE, is a medical examination designed to provide more information to your examiner before deciding your Social Security disability case. The first thing to understand about the CE exam is you shouldn’t panic. These exams are quite common requirements among people who apply for Social Security Disability (SSD) benefits or for Supplemental Security Income (SSI). These exams may be physical, psychological, or psychiatric, depending on the nature of your Social Security claim.
Those who claim a severe back injury that limits their mobility, for example, may have to take a physical exam. Those who claim cognitive problems, such as difficulty parsing facts after a traumatic brain injury, may need a psychological evaluation. Those who claim mood disorders, such as severe anxiety or depression, may need a psychiatric evaluation. These are just a few basic examples, however. Your specific disability and SSD/SSI application will indicate the kind of exam you may need.
Why Does the SSA Need Me to Have a CE Exam?
The purpose of the exam is to gather further information regarding your disability when there are aspects of the application that are unclear or require deeper investigation. In many cases, this can happen because your medical records don’t provide a comprehensive view of the case. For example, if you are complaining about cognitive issues and your medical records indicate you have persistent headaches, but were given medication to control them, further investigation might be required.
In some other cases, your records might be incomplete or just difficult to read if they were handwritten. You may have missed a follow-up appointment and the disability examiner needs to determine your progress. When information is limited, the disability examiner may not have the information needed to render a proper judgment of your ability to function and hold down a job. You may also indicate something on your application that your medical records don’t seem to support. For example, if you mark anxiety and panic attacks on your application, but your records show no treatment, the examiner may want more information.
The disability examiner for your initial application isn’t the only one who might order such an exam, however. If your case requires a hearing before an administrative law judge, the judge may also order such an examination. In such cases, missing an exam can be considered evidence against you and your case can be closed for failing to comply. Because of this, if you ever have to miss an exam for good reason, it’s important to contact the examiner and request a reschedule. These exams are important, common, and part of the review process for your SSD or SSI application.
What Happens at a CE Exam?
What happens at your CE Exam will vary based on the specifics of your case. The exam will be performed by a psychologist, physician, or psychiatrist who is contracted to perform such exams, independent of the examination board. These professionals are paid contractors, not under the employment of the Social Security Administration. That means they’re not on anyone’s “side” and will conduct an impartial examination, reporting the results to the SSA.
The purpose of this exam is to see where you are in the recovery process and the current state of your disability, condition, or limitations. It’s not to recommend a course of treatment or recovery moving forward.
Preparing for the Exam
As you prepare for the exam, the first thing to remember is to stay calm. The exam is a normal part of the application process and should confirm your disability. Plan to show up a few minutes early; it is bad form to arrive late and the doctor may even refuse your visit, which can delay your claim. If you have children, leave them with a relative or find a sitter, if possible, so you and the doctor can focus entirely on the exam.
Bring your driver’s license or other government-issued photo ID and any medication or devices that you use to the exam, such as hearing aids, canes, or other adaptive equipment.
If your disability inhibits your travel to the physician, the Social Security disability law requires that arrangements be made for the doctor to come to you. Contact your disability examiner to inform them you are physically unable to travel to the doctor and see what steps you need to take. In most cases, this involves filing a written request describing your circumstances and the need for the physician to come to you.
Can I Use My Own Doctor?
In some cases, your physician may be able to perform the exam. Your physician must be the correct specialty, however. It’s important to speak with your disability examiner and your physician about their credentials as an Acceptable Medical Source. Keep in mind that some physicians may not be comfortable performing the exam, since the results could lead to a denial that may harm your professional relationship.
If your physician is credentialed and willing, you can file a written request with the disability examiner to visit them. In the request, make sure you state that you’ve already spoken with the physician, they are credentialed, and that they are willing and able to provide the exam. Your examiner will then approve or deny the request.
Bring an Observer and Take Notes
You’re permitted to bring an observer to the exam as a witness. You should take notes during and after the exam to record your experience from your perspective, such as the length of the exam, the questions that were asked, the answers you provided, and any other pertinent information.
The reason for this is that some physicians may have a bias against people applying for SSD or SSI. Attorneys often hear complaints that the physician is mean or condescending, or that the exam was too brief to reveal anything. The more accurate records you keep, the more prepared you’ll be to challenge the results, if necessary. It’s also important to document whether the physician’s specialty is in the area of your disability. For example, if you are applying for SSD based on depression and you are sent to a general practitioner instead of a psychiatrist, you may have a valid complaint.
At the Exam
At your exam, the doctor will conduct an examination (physical or psychological, as required by your claim) and will ask you questions about the nature of your condition. They may also question you about your medical records. You may have to undergo tests based on your condition, such as eye exams, blood work, imaging tests, mobility tests, and other tests.
The questions are determined by your subjective complaints, the ways in which your injury affects your ability to work, and your medical history. When you are asked questions, be honest and forthright. Avoid over- or underestimating your symptoms or the severity of your condition. Cooperate as best you can, even if the physician asks you to move in a way that’s uncomfortable or painful. Making the effort is important, as refusing to do so can affect the physician’s report and the way the SSA reviews the results.
The exam could take a few minutes or an hour or more, depending on how many tests the physician requires. Typically, these exams are brief, which is a common complaint among applicants. If the exam is overly brief or cursory, that could be a sign that the physician isn’t being as thorough as they should, which you should include in your records of the experience.
Be sure to request a written record of the appointment that reflects how long the physician spent with you and what tests were performed. The law requires the physician spend a minimum amount of time with you, which can vary widely based on the type of exam. Don’t mention this legal minimum; just obtain the written record and keep your own notes.
You will not be required to pay for the exam; the office that schedules the exam is responsible for that.
After the Exam
After the exam, the physician will send a report to your Social Security examiner. This report should include:
· A physical description of you that matches your medical records
· Your SSN or non-SSN claim identifier
· Your complete medical history, exam results, lab findings, and diagnoses, in such a way that the independent reviewer can get a clear picture of your ability to perform job duties
· A narrative of the doctor’s findings
· Conclusions the CE offered, which are consistent with other documentation
· A signature and review from the provider
The report should not include the physician’s direct opinion as to whether you are legally disabled and eligible for benefits. That is not for the doctor to determine. Rather, it will be written as a guide for the examiner to draw their own conclusions and may include the doctor’s opinion as to whether you are able to work.
You will not receive a copy of this report, but you may request a complete copy of your file from the SSA that includes a copy of the report and any other pertinent information. Before you can request your file, however, you must be denied benefits at least once. After your denial, you are entitled to request a copy of your file during any appeal stage.
Why Should I Document My Impairment Outside of the CE Exam?
Any time you’re seriously injured, it’s important to document your impairment with as much detail as possible. The more evidence you can provide, the better chance you will have to get your claim for Social Security benefits approved. In fact, if you document it well enough, you may not even need to undergo a CE Exam.
From the moment you get injured, keep detailed records of everything that happens to you, including:
· Doctor’s visits
· Medications you take
· Devices you have to use, such as canes, walkers, and hearing aids
· Physical or occupational therapy visits, treatments, and progress
· The manner in which your impairment affects your life
· Any emotional problems you experience, such as difficulty maintaining relationships, mood swings, depression, panic attacks, and other mental health issues
· Any progress and setbacks you experience
Your notes should include receipts and after-visit summaries physician and specialist visits, medication receipts and records, and all official paperwork. You should also keep a detailed journal of your experiences and the difficulties you face. The more information you have and the more detail you can provide, the more prepared you’ll be for the application process. This way, if you are denied, you can give your attorney a head start on building a case to help you challenge the denial.
Do All CE Exams End in Disability Denials?
Not all CE Exams end in disability denials, but many do. It’s sad, but very often these exams are scheduled just so that the examiner can have an excuse to close the case. While these kinds of exams are common, they’re not always of a neutral intent. Because of this, it’s important to keep records of the physician’s specialty, how the physician treats you, how long your exam is, and whether they ask you relevant questions.
Still, an exam can provide more up-to-date information than was available in your current records, which can allow the examiner to proceed with an approval if the existing, earlier evidence supports it. The same goes for a psychological evaluation. It’s common for people with mental health problems to have a lack of history of care, but if your symptoms do indicate an issue, an evaluation can confirm it. In this case, not only can the evaluation allow your disability examiner to approve your case, but it can provide opportunities for the treatment you need.
The key is that usually when a CE exam is scheduled, it’s often because the examiner is leaning one way or another and they are looking for confirmation of their suspicions. You will have no way of knowing when you get the request whether they are leaning towards denial or approval, so your best option is to simply take the exam and do what is asked of you. Proceed with honesty and do what’s asked of you, keep good notes, and act in good faith.
In some cases, your own attorney may request that the SSA schedules a CE if your claim is denied. This can help them to strengthen your case on appeal. That said, the physician at the CE exam should not be viewed as being on your side and may be biased against you.
What if My CE Exam Doctor Says I Can Work?
Typically, if your CE exam physician thinks you can work, you will be denied benefits. If the physician thinks you can work, but that your capacity for full-time work or the return to your previous job is limited, you may be granted partial benefits and required to find a part-time job suited to your capabilities.
All too often, a CE exam is requested because the examiner is skeptical of your disability and looking for confirmation that you are able to work. Unfortunately, it’s common for SSD and SSI claim denial, either with or without a CE exam taking place.
If this happens, however, it’s not the end of the road and you still have options.
Can I Disagree with My CE Exam?
If you disagree with your CE exam, you can challenge a denial. Doing so means following the appeals process outlined by the Social Security Administration. If you pursue an appeal, you should seek help from a Social Security disability attorney. The process to appeal a denial can be complex and requires someone who knows how to support your case and provide the best argument to get the benefits you need and deserve.
Can I Have a Disability Attorney Fight the Results of a CE Exam?
The first thing to understand is your attorney won’t be challenging the results of your CE exam, since the exam itself was just one small part of your claim review. Instead, they will be using the incomplete nature and conclusions of the exam to challenge a Social Security denial after a CE exam. In fact, you may not even know the results of your CE exam until after you are denied benefits and you request a copy of your file.
This is a subtle, but important, distinction. Your end goal is to get benefits, and to do this you’ll need to file an appeal to get your case reconsidered. There are four different levels of appeal that your attorney can pursue after you are denied. These four levels include:
· Reconsideration
· Administrative Hearing
· Appeals Council Review
· Federal Court Review
The first three levels can be requested online. The fourth, the Federal court review, is more complex.
Reconsideration
A reconsideration essentially starts the process over, but your claim will be reviewed by a new examiner who was in no way associated with the initial application. This new reviewer will look at all of the evidence you originally submitted, and you have the opportunity to submit any new evidence for consideration. You can request a reconsideration for a medical or a non-medical denial.
Administrative Hearing
If your claim is still denied after a reconsideration, you can request a formal hearing before an administrative judge. This judge will have no association with the prior decisions. Such a hearing is held close to your home, usually within 75 miles. If you cannot make it to court, your hearing may be held via video conferencing. After you request a hearing, you will receive a packet that details the process.
Appeals Council Review
The third level of appeal involves your hearing decision before an appeals council, who will determine if the hearing decision was in compliance with Social Security law. The council may decide your case on their own, or they may refer it to an administrative law judge for further review and consideration.
Federal Court Review
The highest level of appeal for your decision is to take it before a federal court. You must have first been denied at the other three levels before taking your appeal to federal court. You can institute a federal court review by contacting the Social Security office.
How a Lawyer Will Help You Before & After your Disability CE Exam
When you fill out our contact form we’ll ensure you get connected with an outstanding disability lawyer as soon as possible. This means you’ll receive a prompt response from an attorney that will ask you the particulars of your situation and work to understand the issues surrounding your case. Usually, these interviews are done right over the phone and you don’t even have to leave your home.
After your case is accepted by a disability attorney, the Washington SSD attorney will work with you to collect all items you’ve already submitted to the SSA and form a case strategy. To do this, you will need to sign a release allowing the attorney to access your records.
Your SSD or SSI attorney may also contact doctors to request additional statements backing up your limitations. They will advise you on which records are not relevant and how to handle evidence that might hurt your case.
Next, your disability attorney will help you prepare for your case. They will go over your records in detail, address any potential problems, and go over the questions you are likely to face at a hearing. They will also consider whether you should have witnesses. Their goal, in the end, is to apply your impairment to Social Security disability law, to prove that it meets the disability listing, to prove that you are unable to work your prior job and that you are too disabled to work even a primarily sedentary job.
They will give you the best shot to challenge a denial and get the Social Security disability benefits you need, which you are entitled under the law. Social Security denials are quite common, but they are not always the end of the world. With the right help, you can challenge a Social Security denial after a CE exam and improve the chances of getting the benefits you need.
Don’t settle if you get a bad feeling after your CE exam, get representation and prepare to fight.
