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

For more information, see:

• Steps To Take If You Receive A Letter Ordering You To Take A Consultative Exam  
• You Can Request That Your Own Doctor Conduct The Examination  
  
• A Request For Your Own Doctor May Be Refused For Reasonable Reasons  
  
• If Your Request To Use Your Own Doctor To Perform A Consultative Exam Is Unreasonably Refused  
  
• How To Protect Yourself Whether You See Your Own Or The Insurance Company's Doctor 
  

It is advisable to immediately call the Analyst and ask the reason for the request.

• If your doctor has not responded to inquiries or to requests for additonal records, you can take on the role of "traffic cop". Ask for a copy of the letter(s) sent to your doctor. Follow-up on each request, and keep following up until the requested information and/or records is sent.  Accept the fact that people tend to do what is "inspected" instead of what is "expected."
• If the analyst believes your doctor is not a sufficient expert in the area, correct the analyst's impression if it is incorrect. For example, if an Internist is treating you for cancer, the analyst may want to have you examined by an oncologist. If your internist happens to also be an oncologist, but the analyst doesn't know it, let the analyst know.
• If the analyst needs additional information that has not been included in your file, as a practical matter, you don't have a choice except to take an exam. If you don't take the requested exam, it is not likely that your claim will be approved. You will have to go through the laborious, and lengthy, appeal process. However, that does not mean you have to see the DDS recommended doctor instead of your own. In fact, it is recommended that you request your own doctor. (See the next section.)

You have the right to request that the Consultative Exam be conducted by your own physician. This is known as a Treating Physician Consultative Exam.

In fact, the Social Security's written policy is that your treating doctor should be considered to be the primary source of information about your condition. Because of this, you may be able to substitute your own doctor for the recommended doctor - at Social Security's expense. It is in your interest for an exam to be conducted by a doctor who has been treating you and knows you and your condition.  

A request to use your own doctor to do a Consultative Exam may reasonably be refused if:

• The doctor is not qualified to do the examination.
• The doctor doesn't have the equipment needed to provide the specific data requested.
• There are conflicts or inconsistencies in the file that cannot be resolved by going back to the treating source.
• Prior experience indicates that your doctor may not be a productive source because he or she does not submit complete reports, or reports on a timely basis..
• The doctor is not willing to perform the additional examination or tests for the fee schedule payment Social Security uses.

If the analyst refuses to let you substitute your own doctor, ask to speak with a supervisor.

Social Security's regulations clearly state that when possible the treating physician should perform the physical examination. If your statement doesn't convince the supervisor, suggest that he or she check Social Security's Listing of Impairments. The provision, which is included on the web at http://www.ssa.gov/disability/professionals/bluebook/#Medical%20Evidence is as follows:

Consultative Examinations ("CE")

If the evidence provided by the claimant's own medical sources is inadequate to determine if he or she is disabled, additional medical information may be sought by re-contacting the treating source for additional information or clarification, or by arranging for a CE. The treating source is the preferred source for a CE if he or she is qualified, equipped, and willing to perform the examination for the authorized fee. (Emphasis added). Even if only a supplemental test is required, the treating source is ordinarily the preferred source for this service. However, Social Security's rules provide for using an independent source (other than the treating source) for a Consultative Examination or diagnostic study if:

• the treating source prefers not to perform the examination;  
• the treating source does not have the equipment to provide the specific data needed;
• there are conflicts or inconsistencies in the file that cannot be resolved by going back to the treating source
• the claimant prefers another source and has good reason for doing so; or
• prior experience indicates that the treating source may not be a productive source.

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.

Keep in mind that your benefits claim may depend on the outcome of this exam.

• Before the exam, call the doctor's office and ask if you can bring a friend or family member and/or record the exam.  
• If the doctor permits, ask a friend or family member to with you as a witness. Ask the other person to take notes during the exam about:
• What was asked and how you responded.
• What tests were done, and the results.
• As a back-up, record the entire exam.
• If the doctor refuses to permit a witness and/or recording, see the next section below.  
• Prepare for the meeting by reviewing:  
• The history of your symptoms.  
• The impact of each symptom on your ability to work and on activities of daily living. Be specific. For example, rather than note that a symptom such as muscle weakness kept you from doing your work, note that the symptom kept you from lifting the boxes that are an integral part of your job. 
• A good place to look for notes on this subject is your symptoms diary if you have one.

Talk over with a close friend or family member what he or she has noticed about your symptoms and how they have affected your work and/or daily life. Often, in discussing your history with another person, the person or you will think of statements and occurrences you had forgotten about.

• Don't downplay your symptoms. One person we know of wants to be liked so much that he downplays his symptoms when he speaks with his doctors. This is self-defeating, particularly when it comes to a determination of whether you are entitled to disability benefits.
• On the other hand, don't exaggerate your symptoms. If you suddenly have unprovable symptoms, it may cast doubt on the reality of statements made when you applied for your disability benefit. 
• If lab tests are done, insist they be read by the same lab that your doctor used before. Different labs can have different results, even with the same tests.
• As soon as you can after walking out of the exam room, review the notes and/or tape to make sure they are complete and to add your own observations. If you left something out, or feel you need to clarify something that was said, do so immediately either by returning to the office or calling/faxing/e-mailing.

If The Doctor Refuses To Let You Tape The Exam And Refuses To Permit Anyone Else In The Exam Room With You

Call the DDS. Speak with the person who sent you the notice about the Consultative Exam. Ask if she or he will contact the doctor for you to arrange your being able to record the session and/or to bring a person with you. The request is not only reasonable, but it is becoming more and more common for patients to record and/or bring an advocate to appointments with doctors.

If the company won't speak with the doctor, of if it does, cannot convince him or her to agree to your request, perhaps the insurer would recommend another doctor who is more agreeable to your requests.

If no company approved doctor will allow you to record the appointment or to have another person present, one alternative is to refuse the exam. However, this will likely stop action on your benefits. If you choose this route, consider writing or at least calling the insurance company.

• Tell the company that you "were willing to take the physical exam" but were refused permission to document the physical. You would like for the insurer to explain why you were refused.
• Offer to take the exam as long as you can record it or understand why it cannot be recorded.
• Send the letter to the insurance company by e mail or fax, with a hard copy by mail, preferably return receipt requested. Send a copy to the doctor. Keep copies of the letter and any response.

Another alternative is to take the exam. If you do, follow the guidelines discussed in the above section: What Can I Do To Protect Myself Whether I See My Own or The Insurance Company's Doctor?

In addition:

• Ask the doctor to write a note confirming that she would not allow you to document it and why. If she is unwilling to put this in writing, it is even more important that you immediately write down all that you remember of the exam including the doctor's refusal.
• Note how much (or little) observation was made of your symptoms and how much the doctor relied on your own statements. For example, if one of your symptoms was shoulder pain, did the doctor have you lift and stretch and move the shoulder around while watching how you reacted -- or did she just have you lift it once and start writing.
• Note what the doctor said. For example, if the doctor said "that looks painful" when you lifted your arm - note it.