The Slippery Slope of Consultative Exams

As part of an initial application or of a continuing disability review, a claimant may be scheduled for a consultative medical examination.

If you know someone being sent to a “consultative examination” by the Social Security Administration (SSA), there are several important to know. The law requires that SSA gives preference to a report from a treating physician to when more information is needed. This is rarely done unless demanded by the claimant. Claimants are routinely scheduled by SSA for full examination and reports from doctors who they have never seen. What can you do to make sure the examiner has all the facts?

First, verify that your own physician has submitted all current records to SSA. A separate physician’s letter stating the diagnosis, clinical findings and functional impairments is best. If SSA has received complete and adequate medical information from a treating physician, it may not be necessary to have a consultative examination from another doctor.

Secondly, be sure your client responds promptly to any requests from Social Security to make an appointment for an examination. Failure to respond to such a request can lead to termination of the claim for “failure to cooperate.”

These preliminary logistics aside, be aware that this can be treacherous territory for a client. Consultative examiners frequently work in large clinics that specialize in these examinations, and have contracts with SSA. The doctors are often not specialists in the pertinent area of medicine. Board certification can be an issue. Tests may be ordered that have nothing to do with the alleged impairment – for example, arm x-rays are ordered when there is a back impairment. Necessary diagnostic tests are not done. We have seen cases where a denial of benefits is issued based entirely on these consultative examinations, with no records from treating physicians.

Sadly, it is often the case that the consultative examiner will not be provided with existing medical records. Although SSA regulations require a general medical examination should take 30 minutes, these exams are often over within five minutes. Doctors are to spend 40 minutes for a psychiatric exam, under SSA regulations. Claimants report very brief encounters for these exams. The written report results can be damaging, especially when based on incomplete information.

We often will arrange to send medical records to the exam with the patient. You can send a witness along with the patient to note the time spent. Consider whether the claimant should have an attorney at this point in the claim. While the collaboration of consults and second opinions are welcome in most medical situations, they are rarely good news in a Social Security claim.