A consultative examination is a physical or mental examination or test purchased for you by Social Security at its expense from a medical doctor, psychologist or a pediatrician when appropriate. The decision to purchase a consultative examination is made on an individual case basis by Social Security when it feels the evidence as a whole is insufficient to allow a decision on your claim.
Some reasons a consultative examination may be ordered include:
- The additional evidence needed is not contained in the records of your medical sources;
- The evidence that may have been available from your treating or other medical sources cannot be obtained for reasons beyond your control, such as death or noncooperation of a medical source;
- Highly technical or specialized medical evidence that is needed is not available from your treating or other medical sources.
Social Security says it will purchase a consultative examination only from a qualified medical source. By “qualified,” it means that the medical source must be currently licensed in the State and have the training and experience to perform the type of examination or test requested; must not be barred from participation in SSA programs; and must also have the equipment required to provide an adequate assessment and record of the existence and level of severity of the medical impairments
Consulting examiners don’t always meet these requirements. On February 6, 2015 a class action lawsuit was filed in federal district court in San Francisco against the Social Security Administration (SSA) by claimants who were deprived of disability benefits because of SSA’s continued reliance on medical reports from a doctor who had been disqualified. The grossly deficient reports were based on cursory examinations (often lasting ten minutes or less), referenced tests that were never performed, and reported findings that were inconsistent with the claimants’ medical records. On the basis of these faulty reports, plaintiffs who were no longer able to work were denied Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits, essential to their well-being.
If you undergo a consultative examination, you should remember and write down what occurred during the examination. You may need to testify about how thorough the evaluation actually was if you need to appeal your disability claim.