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Is a consultative exam good or bad for your SSD claim?

On Behalf of | Jun 13, 2022 | Social Security Disability

You’ve been waiting for what seems like forever to hear something about your Social Security Disability (SSD) claim. When you finally do, however, it’s just a notice that the claims examiner from the Disability Determination Services (DDS) wants you to go to a consultative exam.

Is this good or bad news? It depends. Here’s what you should know:

What’s a consultative exam?

A consultative exam is performed by a doctor (other than your own) at the Social Security Administration’s (SSA) expense. The goal is for the doctor to give SSA more clarity about your condition.

Here’s the good news: If DDS had enough information to deny your claim, they would. In that respect, the consultative exam is an indicator that there is:

  • Either little or no current medical information in your file, often because your own medical providers have been slow to respond to requests for information or because you haven’t had recent treatment for one or more of your conditions. In this case, SSA is being thorough.
  • Conflicting information in your file that doesn’t lead to a clear approval or denial, usually because your own treatment providers are unclear in their notes or hold differing opinions about the severity of your condition. A consultative exam can tilt the odds in your favor.
  • Forward momentum on your claim. Usually, it doesn’t take long to get a decision once the consultative report has been delivered to DDS.

Here’s the bad news: The doctors who perform these exams are (supposedly) independent, but the reality is that many of them make a good living from SSA referrals. If they’re seen as overly sympathetic to patients, those referrals could dry up. That means:

  • Some of these doctors are more concerned about not appearing patient-friendly than they are in giving patients a fair evaluation.
  • Some of these doctors are jaded, so they look for “evidence” that proves a patient is malingering. That can include having a receptionist secretly observe waiting room behavior or even following a patient to their car to see if they seem healthier outside of the examination room.

You can’t refuse to attend a consultative exam without putting your claim in danger, but you should go in with a wary mind. Experienced legal guidance can also help you better understand what to expect and get your SSD claim approved.