What Is a Consultative Examination (CE) in a Social Security Disability Case?

What Is a Consultative Examination (CE) in a Social Security Disability Case?

If you have applied for Social Security Disability or SSI benefits, you may receive a notice from the Social Security Administration asking you to attend a medical appointment with a doctor you have never seen before.  This is called a Consultative Examination, often referred to as a “CE.”

Understandably, most people have the same question: “Why do I have to see this doctor?”

What Is a Consultative Examination?

A consultative examination is a medical evaluation scheduled by Social Security when there is not enough medical evidence in your file for them to make a decision.  Instead of sending you for treatment, Social Security sends you to a doctor whose role is simply to:

• examine you
• evaluate your condition
• and provide a report to Social Security

These doctors are contracted by the Social Security Administration and are not your treating physicians.

Why Is Social Security Sending Me to This Exam?

There are several reasons why a consultative exam may be scheduled:

• You have not been able to see a doctor regularly
• Your medical records are limited or outdated
• Your records do not clearly explain your limitations
• Social Security needs additional information about your condition

In short, Social Security is trying to fill in gaps in your medical records.

What Should I Expect at the Exam?

Most consultative examinations are relatively brief—often lasting 15 to 30 minutes.

The doctor may:

• ask about your medical history
• perform a basic physical or mental evaluation
• test your movement, strength, or memory
• ask questions about your symptoms

It is important to understand:

???? This doctor is not there to treat you
???? They are there to evaluate you for Social Security

The CE physician should have access to some of your medical records, but it is rare for them to have a complete copy of your medical file, so be sure to inform them of all the medical providers you are receiving treatment from and what condition(s) they are treating, including any medications prescribed and their side-effects.

Are Consultative Exams Always Reliable?

Consultative exams can provide useful information, but they do have limitations.

For example:

• The doctor may not have access to all of your medical records
• The exam is based on a single visit, not ongoing treatment
• The evaluation is often brief
• MRIs, X-Rays and other tests are typically not performed during the consultative examination.

Because of this, a consultative exam usually provides only a snapshot of your condition on that particular day.

Do I Have to Go?

Yes—if Social Security schedules a consultative examination, you should make every effort to attend.

Failing to attend can result in:

• delays in your claim
• or even a denial of benefits

If you truly cannot attend, you should notify Social Security immediately and request that the exam be rescheduled.

Is the Consultative Exam Enough to Win My Case?

In some cases, a consultative exam may support a finding of disability.

However, most of the time, it is not enough on its own.

Social Security places greater weight on:

• your treating physicians’ records
• ongoing medical treatment
• consistent documentation of your limitations

The consultative exam is just one piece of the overall evidence.

A consultative examination can feel confusing or even frustrating, especially when you already have a medical condition you believe should qualify you for benefits.

However, it is simply part of the process Social Security uses when additional information is needed.

The most important things to remember are:

• attend the appointment
• be honest about your symptoms
• understand that the exam is only one part of your case

If you or someone you care for has recently been denied Social Security Disability benefits, or if you just have questions about your right to disability benefits, please do not hesitate to contact and speak with one of the experienced  Social Security Disability Lawyers at Powell and Denny today for a free consultation; and remember, virtual appointments are available through Zoom so you can meet with one of the attorneys of Powell and Denny from wherever you live. And remember, there is no fee unless you win.

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What Is a Consultative Examination (CE) in a Social Security Disability Case?