Consultative Exams and Why You May be Scheduled for One

By Disability Group

Many claimants who apply for disability benefits are scheduled for a Consultative Exam at some point throughout the decision-making process. It is normal to be unsure of what this means and why you may be scheduled for one. After you file your initial application, the Social Security Administration will forward your claim to Disability Determination Services (DDS) where it will be assigned to an adjudicator. The adjudicator is responsible for collecting all of an applicant’s relevant medical records pertaining to their disability. If the adjudicator is unable to gather enough medical records to make a decision, they will schedule a Consultative Exam (CE) for the claimant, which is an appointment with one of Social Security’s doctors.

Here are some reasons an adjudicator may find that an applicant’s medical records are insufficient:

  • Applicant’s doctor did not supply up-to-date medical information
  • Applicant’s doctor failed to respond to medical records requests
  • Records indicate a possibility of having a condition with no follow-up
  • Applicant fails to complete and return questionnaires supplied by the adjudicator
  • Applicant has not been to the hospital or seen a doctor that can supply medical evidence regarding their alleged condition

Any one of these reasons can lead to the scheduling of a Consultative Exam.

Will a Consultative Exam hurt my case?

When a Consultative Exam is scheduled, Social Security has to pay the bill, so the adjudicator would not schedule a Consultative Exam unless it is absolutely necessary. Once the exam is scheduled the adjudicator will mail out a notice informing the applicant of the exam’s date, time and location. The only reason a Consultative Exam would hurt a claim is if the applicant fails to attend. Failing to attend can almost certainly lead to a denial since the adjudicator would not have scheduled the Consultative Exam if they thought they had enough information to make a favorable decision on the claim.

One must understand that the doctor completing the Consultative Exam is only attempting to gather information regarding a specific condition. The exam is conducted to ‘fill in the blanks’ of the medical evidence provided. To avoid a Consultative Exam and save time during your claim, it is good to have copies of your medical records with you (pertaining to all of your disabilities, not just your main condition) and to inform your doctors to expect requests for records from Social Security.