Securing adequate evidence in disability claims

Medical evidence is decisive in Social Security Disability claims, as most Social Security lawyers in Chicago know. If a person seeking SSD benefits does not have an adequate medical record or documentation, the disability claims examiner may not be able to determine whether the applicant qualifies as disabled. To move the claim forward, the examiner may order a consultative examination, which is an independent medical examination.

Nature of exams

A consultative examination may be necessary if an applicant has not recently sought treatment for the disabling condition. The Social Security Administration requires current medical records to establish a medical condition. A consultative exam may also be ordered if information is missing from the applicant’s medical evidence.

When possible, the SSA contacts the applicant’s treating medical source for additional information or supplementary testing. However, in some cases, a consultative examination may be preferable. For instance, if the treating source appears unreliable or refuses to perform the necessary examination, the SSA may order a consultative exam. The SSA requires these exams and the resulting reports to meet the following requirements:

  • The report must be comprehensive enough to allow a third party to understand and evaluate the disabling condition. The report should discuss the applicant’s medical history and the results of the exam.
  • The report should address all of the applicant’s prior medical records and any complaints the applicant has made.
  • The examining physician should give an evaluation of the applicant’s ability to perform physical or mental job-related tasks. However, the physician cannot state whether he or she believes the applicant is disabled.
  • The report and its conclusions must be consistent with the existing medical evidence.

Social Security lawyers in Chicago are often asked what the consultative exam involves. The specific nature of the exam depends on the information the claims examiner requests. A consultative exam may be physical, psychological or psychiatric, and it may include various diagnostic tests.

Potential challenges

If a consultative examination is ordered, attendance is essential. Failure to attend the examination without good reason can be grounds for claim dismissal. Applicants who receive instructions to attend a consultative exam should notify the SSA as soon as possible of any scheduling conflicts.

Applicants should also recognize the inherent limitations of consultative examinations. These examinations are typically short, and the conducting physician is not familiar with the applicant’s medical history. Although physicians receive each applicant’s medical records prior to the exam, some physicians may not review them thoroughly enough.

These limitations may lead to an unfavorable decision for applicants. People who receive notice of claim denial after a consultative examination may want to speak with Social Security lawyers in Chicago about appealing the decision.