Business people working in groupGathering additional medical evidence

The Social Security Administration requires extensive medical documentation from people seeking Social Security Disability benefits. As any Illinois disability lawyer knows, the SSA cannot reach a decision if medical evidence is incomplete or outdated. For this reason, it’s not uncommon for the SSA to order consultative examinations. These examinations allow the SSA to secure any additional medical evidence needed to support a final claim decision.

Supplementary evidence

A consultative examination includes an examination and any objective tests that the SSA has requested. The examination and laboratory tests may be physical, psychological or psychiatric in nature. An independent physician, rather than the applicant’s regular treating physician, conducts these examinations.

SSD applicants don’t receive treatment during consultative examinations. The goal of the examination is to produce a comprehensive report of the claimant’s condition and associated limitations. This report should essentially allow an SSD claims examiner to fully understand the applicant’s condition without reviewing additional evidence. The final report should include the following information:

  • An overview of the applicant’s medical history
  • The results of the physical, psychological or psychiatric exam
  • Clinical findings from any objective tests performed

The physician who conducts the consultative examination also must complete an assessment of the applicant’s ability to work. This evaluation must be consistent with the applicant’s prior medical records and with the information included in the report. However, the physician may not offer an opinion about whether the applicant qualifies as disabled under SSA standards.

Failure to cooperate

Failure to attend a consultative examination will result in a delayed claim decision, as any Illinois disability lawyer could confirm. This is because a consultative examination is only ordered when essential evidence is lacking. Applicants who miss examinations also risk having their claims dismissed, since failure to cooperate provides grounds for claim dismissal.

The SSA typically sets up mandatory consultative exams without consulting applicants, so some people may experience legitimate scheduling conflicts. When this is the case, applicants should promptly notify the SSA so that a new exam date can be set.

Exam accuracy

As an Illinois disability lawyer could explain, consultative examinations may not provide the most favorable source of evidence in SSD claims. This is because the physician conducting the examination is generally unfamiliar with the claimant’s condition and medical history. As a result, the physician may assess the disability differently than a treating physician would.

This unfamiliarity may be a significant issue if an applicant’s existing medical records are limited. If the examination is only needed to update the claimant’s records, however, the negative effects of a poor assessment may be reduced. This is one reason that claimants can benefit from providing comprehensive, current medical records throughout the SSD claim process.