What are Consultative Examinations and Why Do I Have to Go?



consultative medical or psychological evaluationIn many of the cases I handle, my clients receive notice of consultative examinations by medical doctors (for physical impairments) or psychologists (for mental health impairments).  These consultative evaluations are scheduled by Social Security – and we do not get to choose the  examining physician or therapist and usually we have no opportunity to communicate with these health care professionals.

Why are Consultative Examinations Scheduled?

Under the law, the Social Security Administration is required to help “develop the record” of individuals who file applications for benefits.  There have been a number of cases in which Administrative Law Judge denials have been reversed when SSA has not sent claimants out for consultative examinations.

You would think that SSA would not bother with the time and expense of paying for claimants to visit independent doctors if that claimant is receiving on-going treatment, but this is not the case.  It appears to me that SSA has a policy in place to send just about every disability applicant out for a consultative examination.

Who are the Doctors that Provide these Examinations?

SSA maintains a panel of physicians and psychologists that serve as consultative examination providers.   These providers have agreed to a reduced fee in exchange for regular business.

Often the medical doctors who examine claimants for physical impairments are “industrial clinic” doctors – the same physicians who may provide evaluations in workers’ compensation cases.  In my experience, consultative physical examinations are rarely helpful to my clients – most of these doctors are not inclined to find any significant impairment.

If your impairment arises from a physical problem such as back pain, knee pain or even heart trouble or breathing issues, you should not expect much help from the physical medicine consultative examination.  I can also tell you that most of the North Carolina based judges I see in Social Security hearings are aware that these physical medicine exams are fairly useless and they pay the doctors’ conclusions little heed.

By contrast, it has been my experience that the mental health evaluations (the psychological consults) often do produce helpful evidence.  Psychologists, after all, make their living providing on-going treatment and they are less likely to be corrupted by a workers’ compensation bias (consulting psychologists are rarely used in workers’ compensation cases).

Therefore, I find that the psychological consults often yield some evidence of impairment that we can use to eliminate categories of jobs.  I have also won more than a few cases based primarily on the consultative psychological reports.

Do I Have to Go to the Consultative Evaluations?

Social Security cannot compel you to attend the consultative examinations it has scheduled but if you do not go, your refusal will be noted by the judge and your failure to cooperate will be held against you.  I advise my clients that it is in their best interest to attend any consultative examination scheduled, and to call me thereafter, or at least write down what happened.

Often, my clients will report that the doctor (usually in a physical exam) spent about 5 minutes with my client and I can raise that fact during testimony and then argue that the judge ought not give the report much weight.  The mental health exams, as note above, are often helpful.

If you have any questions about consultative examinations in your Social Security case, please feel free to call me or email me.

About

Vaughn Clauson is a US Air Force veteran, and an experienced disability attorney. Vaughn is a board certified specialist in Social Security disability law and has dedicated his career to representing the disabled. Vaughn and his associates have represented thousands of clients, and have experience with any type of disability claim.

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