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Consultative Examination

Summary

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A state agency (generally referred to as Disability Determination Service or DDS) determines whether your health condition satisfies the requirements of Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI). If the DDS Analyst doesn't have enough information from your medical record to determine if you are disabled, or if your records are believed to be too incomplete, the Analyst may arrange with a doctor or psychiatrist for what is generally referred to as a "Consultative Exam".

Consultative Exams are paid for by Social Security. (If it costs you money to travel to the exam, ask for reimbursement of your costs).

If DDS wants you to undergo a Consultative Exam, you will receive a letter, usually about a month after the interview, giving you the name, address and date and time of your appointment with a physician. The physician is one who contracts with Social Security.

DDS will let you know the type of examination or test(s) it needs to help decide whether you qualify for Disability benefits. It may be as simple as a test such as an X-ray or an EKG. Alternatively, DDS could request a more comprehensive examination.

While it is not a written rule, the experience of many people who deal with the Social Security Administration regularly is that a Consultative Exam is requested when an analyst is leaning toward denying a claim. The Consultative Exam can be useful in helping document in the file a reason for the denial. You can imagine how little helpful information a doctor can provide if she or he has never seen you before and only spends fifteen to twenty minutes or less examining you. On the other hand, it could just be that your record doesn't have enough information so the analyst wants to collect more.

You have a right to request that your own doctor conduct the exam. Social Security can refuse the request if the doctor doesn't meet specific criteria.

Whether your own doctor or the insurance company's examines you, you can take steps to protect yourself and improve your chances of getting your claim approved.

Note: See: What To Do If You Are Asked To Take A Consultative Exam

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