Consultative Exams ordered by the Social Security Administration

Occasionally, the Social Security Administration will order a claimant for Social Security Disability Insurance or Supplemental Security Income to undergo a consultative evaluation by a physician or mental health professional of the Administration’s choosing. There are three important things to remember in association with these notices.

First, the evaluation is not optional, it is mandatory. Failure to appear at the date and time scheduled for the evaluation may result in the denial of benefits for failure to comply with the Administration’s directives. These evaluations are most often ordered when a claimant alleges a particular condition for which they either (a) are not receiving regular treatment or (b) the treatment records are insufficient to determine the severity of the condition.

Second, despite the fact that these evaluations are ordered and paid for by the Administration, they are not for the purpose of denying the claimant and in some cases, the evaluation supports a finding a disability. As stated above, these evaluations are often ordered when the medical records from a claimant’s treating sources are either insufficient or silent on a particular condition the claimant alleges is disabling. Frequently, when a claimant does not have the means to see a doctor regularly, the Administration will provide these evaluations to determine the claimant’s actual severity of impairments.

Third, and most important, following the instructions provided on the notice of evaluation. The notice will provide the name of the evaluator, a location and an appointment time. In many cases, the notice will also ask that the claimant bring someone with them to the evaluation who is familiar with their condition. Be prompt to the appointment and bring a close friend or family member who knows the symptoms of your conditions. Following the evaluation, this individual will be interviewed separately from the claimant regarding their own observations of the claimant’s impairments, particularly if the claimant has alleged problems with memory and concentration.

The Social Security Administration, in its analysis of a disability claim, must review medical information related to a claimant’s alleged disabling conditions and in the absence of records or insufficient records regarding a particular condition, consultative examinations are one way to procure the necessary medical information. Claimants are reminded to always comply with Social Security’s directives and participate fully and freely in consultative evaluations, which have the potential to support a finding of disability for the claimant.

Attorney Jennifer J. Allen is an associate attorney with Alan C. Olson & Associates, S.C. If you have any questions about Social Security Disability, please contact her at [email protected].

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