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What's a consultative exam and why does SSA say I need one?

Imagine that you have become disabled and you go through all the steps to apply for the benefits you believe you are entitled to under Social Security Disability Insurance. You've done your homework and think you've submitted all the paperwork required.

You're sure every jot and tittle has been covered and then you get a letter from the Social Security Administration informing you that you must go to XYZ doctor for a consultative examination. What does that mean and why is it needed?

Chances are something is missing and as a result officials don't feel they can make a valid determination of your claim of disabled status. Maybe the information you provided is not current enough. Maybe the request you submitted to your doctor to share your records didn't get fulfilled.

Either way, if officials feel they lack necessary evidence of your condition, you will likely get such a letter. On the bright side, your claim hasn't been rejected. When that happens, the appeals process that is triggered can get even more complicated, confusing and time consuming.

What this all points to is the importance of understanding and addressing possible issues that could derail your benefit application early on.

So, what does the receipt of a consultative examination letter mean? According to the SSA itself it means that, in order to make a determination, it's requiring you to go to the doctor to address specific questions. Preferably your primary health care provider does this, but the agency might send you to a provider of its choice. In either case, the SSA pays the bill and may even pay to get you to the appointment.

You may choose to refuse the exam, but if you do without having a good reason, it could negatively affect your application.

Obviously, it's advisable to avoid tripping the consultative exam breaker switch to obtain a successful claim outcome.

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Melissa A. Proudian, Attorney at Law
1500 W. Shaw Avenue, Suite 403
Fresno, CA 93711

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