The Social Security Administration (SSA) often orders consultative exams (CE) in disability claims. If SSA believes more information is needed to make a decision, they will order a CE. By federal law, the CE must be performed by a “qualified medical source.” These sources must understand SSA’s regulations and practices.
SSA and its adjudicators rely on what appears in a CE report. The exam findings and opinions in a CE can make or break a claim. For more information, contact our experienced Social Security disability attorneys today.
ES Exams performs exams for SSA. It hosts these exams at different locations in Missouri, sometimes on Saturdays at chiropractors’ offices. You may have received a CE appointment notice like this:
ES Exams holds itself out as “a company that provides expert medical opinions for the state of Missouri and Kansas regarding disability status for its residents.” ES Exams states that it will soon be serving Northwest Arkansas, as well.
ES Exams was founded by Dr. Nicholas Evans. However, Dr. Evans appears to contract many of the CE exams to other physicians and nurse practitioners. These “moonlighting” physicians and nurse practitioners often perform CEs after hours and on the weekends. SSA is responsible for the oversight of its medical consultants. However, Social Security has previously agreed that additional actions are needed to ensure that its medical consultants are properly screened and trained.
The moonlighting physician performs an exam and signs a report. ES Exams returns the report to SSA, and SSA treats the report as expert evidence. Many of our clients report inaccuracies in these reports. Because the reports are built from a template, it is common for the reports to contain exam findings for exams that may not have actually been performed.
These CE challenges are systemic. Payment rates for CEs are low (often below Medicare levels). These systemic problems became a matter of public interest with a separate CE supplier, Midwest CES. (Midwest CES now operates as Summit Medical Exams.)
Before your CE, consider taking someone with you. After attending your CE, take notes about your recollection of what happened.
CEs are usually available to a claimant and a claimant’s representative within a matter of weeks. It is worth comparing the findings in the report to your notes about what you recall from the exam. If there are inconsistencies, the adjudicator (usually Disability Determination Services or the ALJ) should review and consider those. In some cases, a new CE or medical opinion may be required. In other cases, SSA may consider the objections and choose not to rely on the CE in deciding the claim. The CE is not the only source of medical evidence, but it is often an important one.
If you have attended an exam at ES Consulting another Social Security disability CE and were not treated fairly, please call, text, or e-mail us.
(816) 781-4836