Most people think that when they file for Social Security disability, they will be examined by a doctor who works for the SSA and who will make the final decision on their disability.
This is simply not true. In fact, many disability applicants are never referred to a doctor by Social Security at all.
When Does Social Security Order an Exam?
Social Security only schedules a Consultative Examination, or a ‘CE,’ when it believes there is not enough medical evidence in the claimant’s file to make a decision.
In other words, Social Security first looks at the medical records from your own doctors, hospitals, therapists, and other treatment providers. If those records provide enough information about your medical conditions and limitations, Social Security can make a decision without sending you for an additional exam.
Why a Consultative Exam Is Not Always Good News
Many people assume that being sent to one of Social Security’s doctors is a positive sign. Unfortunately, that is often not the case.
A Consultative Examination is usually ordered because Social Security feels something is missing from the evidence. For example, there may be very little recent treatment, gaps in care, or a lack of information about how your condition affects your ability to work. SSA does not have enough medical proof from your own treatment providers to fully evaluate your claim.
That can be a problem because the strongest evidence in a disability case generally comes from the doctors and providers who have treated you over time and understand your limitations.
Consultative Exams Can Cause Significant Case Delays
Another reason that being scheduled for a Consultative Examination is usually not a good sign is that it can significantly delay your case. By the time Social Security orders an exam, a doctor at the disability office has already reviewed your medical records and determined that there is not enough evidence to make a decision.
The disability office then must schedule the examination, which may not take place for several weeks or even longer. After the exam has been concluded, the doctor who performed it has up to 30 days to submit a written report. Once that report is received, your case goes back into line to be reviewed by a disability doctor again before a decision can be made.
As a result, a Consultative Examination can add several weeks or even months to the processing time for your claim.
The Difficulty with One-Time CE Exams
Most Consultative Examinations are brief. The doctor may spend only a few minutes with you. They might perform a basic physical examination, ask a few questions, and then prepare their report for Social Security.
Your Doctor’s Purpose vs. A Consultative Examiner
A successful relationship with a doctor is generally built over time. The better your doctor knows you, the more insight they have into your long-term health.
And here’s something you probably don’t know: the doctors that are contracted by SSA to perform CEs are typically paid a flat fee for each examination they perform. Whether they spend 10 minutes or an hour with you, the payment is generally the same. As a result, there is little incentive to conduct lengthy evaluations. These exams often provide only a brief snapshot of how a person is functioning on a single day.
People with chronic pain, mental health disorders, autoimmune diseases, migraines, multiple sclerosis, fibromyalgia, and many other conditions often have good days and bad days. A brief examination cannot accurately reflect how consistent and severe their symptoms are over time.
A person may push through pain during the appointment. They may be having a relatively good day. Or they may simply not have enough time to explain everything they are experiencing. But, if the report from this single examination is a main piece of evidence used to decide your disability case, it might not accurately reflect your overall health.
Why Your Own Doctors Are More Important
A treating doctor has something a Consultative Examiner does not have: a history with you.
Your treating providers may have seen you for months or even years. They have observed how your symptoms change over time. They have reviewed test results, prescribed treatment, monitored your progress, and documented ongoing problems.
This type of evidence is called longitudinal evidence, and it is much more valuable than a one-time examination.
Longitudinal evidence helps show the full picture of your medical condition, including how long your symptoms have lasted, how severe they can be, what treatments have been tried, and whether those treatments have been successful.
The Bottom Line
No, Social Security does not send everyone who applies for disability to a doctor for examination.
Social Security usually orders a Consultative Examination only when there is not enough evidence from your own medical providers to make a decision.
While these exams can sometimes help fill gaps in the record, they are no substitute for a history of strong medical evidence from doctors who have treated you over time.
Your treating providers are usually in the best position to explain how your impairments affect your ability to function on a regular and continuing basis.
That is why one of the most important parts of any disability claim is making sure Social Security receives complete and up-to-date records from your own medical providers.
Disability Advocates has created written guidelines you can share with your health care providers to ensure that you have all of the medical evidence necessary to support your claim to benefits.