What Is a Consultative Exam?

Applying for Social Security Disability can be a long and frustrating process. As part of that process, you may need to go through a consultative exam, which helps to establish the extent of your disability. What is a consultative exam, and what can you expect from that process? Make sure you are prepared by consulting with a member of our legal team.

Given our firm’s litigation experience against CE providers and the SSA, we know how important it is to approach these exams with caution and preparation.

What Is a Consultative Exam?

A consultative exam is an examination from an independent provider, paid for by the Social Security Administration, that seeks to establish the extent of an applicant’s disability and provide more information about their medical needs. A consultative exam can include a physical evaluation, a mental evaluation, or both, depending on the type of disability and the benefits needed.

Who Needs a Consultative Exam?

A consultative exam is not needed by everyone applying for Social Security Disability benefits. Typically, it is required for patients deemed to have insufficient medical evidence of their disability or who have significant gaps in their medical information. However, in our experience, the SSA orders consultative examinations in at least half of all claims—and not always for the right reasons.

The exam can be used to:

• Provide clarity when your records show conflicting medical opinions
• Offer more information about your specific condition
• Establish the full extent of your limitations or challenges

A consultative exam offers an opportunity for the applicant to present more specific evidence of their losses to a medical examiner as they apply for disability benefits. Unfortunately, this system has been subject to abuse—something we have documented in litigation and that has been publicly reported by KSHB and the Kansas City Star.

What Happens During a Consultative Exam?

A consultative exam for a physical disability may include a general physical exam, specific tests, or X-rays. In the case of a mental disability, patients may undergo a psychological or psychiatric evaluation that will provide more insight into their condition.

The care provider will document symptoms and provide an independent assessment of the patient’s physical and mental capability. The doctor may also provide information about the patient’s limitations and how they may impact their ability to work.

Some consultative exam processes may require a single office visit, while others may require the applicant to go through several visits. In some cases, more than one provider may be needed to assess the full extent of the disability.

Does a Consultative Exam Mean the Application Approval Is in Danger?

Some applicants worry that a consultative exam means that their application is in danger or that the exam means they may not receive the benefits they need. However, a consultative exam is not the first step toward disability benefit denial. Rather, it offers an opportunity for a deeper assessment of the applicant’s condition. This assessment can help clarify any issues that may have come up during the evaluation of the application and allow applicants to better present their claim.

This being said, if your exam was unusually short or the results of your consultative exam note that you underwent tests you do not recall completing, you may be at risk of having your application denied. Our office alone has uncovered nearly 250 instances in which examiners have falsely represented the tests their patients completed in order to complete more examinations, and in turn, receive more payments from the SSA.

If you are worried that your consultative exam was not conducted appropriately, our lawyers can help provide reassurance and support.

Contact a Social Security Disability Attorney to Learn More About Consultative Exams

If you have more questions about a consultative exam and how it has the potential to impact your application for disability benefits, a lawyer can provide vital support.

At BurnettDriskill, Attorneys, you will find the legal support you need to navigate SSDI claims and determine your next steps, including clear advice about how to navigate a consultative exam. We are not only here to help—we’re also working to hold bad actors accountable. Contact us today for more information.