When applying for Social Security Disability Insurance (SSDI), some applicants may be asked to complete a consultative medical exam. This may be required in the event that the applicant’s current medical records are not sufficient to complete a fair review of their claim. As such, understanding what this exam is and why it is required can help you adequately prepare for this step in the process. Continue reading to learn what you can anticipate from your consultation exam and how an experienced New Jersey SSDI attorney at The Law Offices of Sheryl Gandel Mazur can help you prepare for this.
What Is a Consultative Examination?
A consultative exam is a type of medical exam that the Social Security Administration (SSA) may schedule for an SSDI applicant if it believes the applicant provided an insufficient amount of medical evidence. It’s critical to understand that these examinations are not intended to provide treatment, but rather to assess a person’s inability to work.
Why The SSA Orders Consultative Examinations
- Medical records are incomplete, outdated, or missing
- There is conflicting medical evidence
- The applicant’s treating provider’s records do not describe functional limitations
- Specialized testing is required that was not performed by previous providers.
Who Performs Consultative Exams?
In general, the SSA will make an effort to schedule the examination with the applicant’s treating physician. However, if the provider is unable to conduct the exam or is unavailable, the SSA can select an independent medical professional to perform the examination.
When Another Provider May Be Selected
- The treating provider declines to perform the examination
- The treating source cannot resolve inconsistencies in the applicant’s records
- The SSA had determined that an independent review is necessary
- Prior exams were insufficient
What Happens During a Consultative Exam?
During the exam, the provider will collect information about the applicant’s medical condition and functional limitations. The scope of the exam itself will depend on whether or not the applicant is filing a claim for physical impairments, mental impairments, or both.
What the Examiner May Evaluate
- Medical history and symptoms
- Ability to perform basic work-related tasks
- Physical movement and strength
- Coordination and balance
- Cognitive function and concentration
- Lab work, like blood tests and diagnostic imaging
What the Consultative Examiner Does Not Do
It’s important to understand the limitations of the physician tasked with performing a consultative exam for those applying for SSDI benefits. In general, they cannot provide treatment, nor do they determine whether or not an applicant should be approved for benefits.
Clarifications of Common Misconceptions
- The examiner cannot provide medical treatment
- The examiner cannot advocate for or against an applicant’s claim
- The examiner does not determine the final decision made by the SSA
- The examiner will not replace the records from your treating provider
Practical Issues That May Impact Your Claim
Unfortunately, logistical issues surrounding a consultative examination can impact how the SSA views your case. As such, an applicant must attend and complete the exam as scheduled, unless prior accommodations have been made and approved by the administration prior to the date of the exam.
Logistics and Accommodations
- Language interpreters may be provided by the SSA
- Claimants may seek approval to use their own interpreter
- Home or alternative exam accommodations may be available in limited circumstances
- Failure to attend the scheduled exam may result in adverse action for a claim
Requested Interpreter Requirements
To be approved by the SSA, your interpreter will have to have the following qualifications:
- Your interpreter must be able to read, write, and speak fluently in English and your language
- Your interpreter must provide an accurate interpretation of questions and responses between you and the physician
- Your interpreter must be familiar with basic medical and social welfare terminology.
- Your interpreter must agree to comply with the SSA’s confidentiality of information requirements
- Your interpreter must not have a personal stake in the outcome of your SSDI benefits claim
Why the Outcome of a Consultative Exam Matters
As you can see, your consultative examination can have a significant impact on whether or not your claim is approved. Though it is not the only factor considered by the SSA, it will become part of your permanent record and may be weighed even more heavily if additional medical evidence is limited. That is why taking this review seriously is critical to seek the best possible outcome for your SSDI claim.
How a New Jersey SSDI Attorney Can Assist You
If you are considering applying for SSDI benefits in New Jersey, working with an experienced attorney with the Law Offices of Sheryl Gandel Mazur from the start of this process can help improve your chances of a favorable outcome. Not only can your attorney help assess your eligibility, but they can also assist you in filing the application, understanding your rights, and appealing in the event of a denial. Contact our team today to learn how we can represent you.
