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Consultative Examinations and SSDI Claims

Author: Jonathan Ginsberg

Published: 2010-05-18 : (Rev. 2013-06-08)

Synopsis and Key Points:

Be aware that not every disability case will require the services of a CE.

Main Digest

Be aware that not every disability case will require the services of a CE

What are consultative examinations

Where social security disability (SSDI) hearings are concerned, consultative examinations are oftentimes requested in an effort to obtain the opinions of outside medical professionals in order to evaluate MS disability claims. Although the SSA will always evaluate and take into consideration all of your treating physician's and specialist's records, they may also require you to submit additional evaluations by an independent medical professional. This is done in order to obtain additional substantiating evidence on your behalf.

The function of the consultative examiner

The SSA will select the CE who is ordered to examine the claimant. Depending on the nature of the claim, the claimant may be referred to a psychiatrist, a psychologist, or regular physician in order to obtain an independent opinion. The claimant is not going to be treated by the professional who performs the consultative examination. Their function in your Social Security Disability hearing is to conduct an examination, prepare documentation relative to their findings, and then submit that documentation to the ALJ hearing your case.

As the claimant, you are allowed to read their report, called a Disability Determination Evaluation (or DDE) prior to the hearing. The DDE will be considered by the SSA in order to determine whether or not they are going to award you any benefits. Just be aware that not every disability case will require the services of a CE. Based on the individual facts involved in the case, some cases will already have several evaluations documented.

Additional considerations with CE's

Should a claimant be suffering with more than one medical or psychological condition, the SSA may order additional CE's from several different specialists such as neurologists or orthopedists for example. The SSA determines whether or not a CE is needed and their decision will typically be based upon certain factors relative to additional medical evidence that is needed above and beyond the current documentation on hand.

This required information includes:

clinical findings

diagnosis

lab tests

prognosis

other clinical reports

Additionally, the SSA pays for the consultative examination and when one is requested, the claimant is obligated by law to participate.

Consequences of not showing up for your CE

There is a good possibility that the SSA will deny your benefits if you do not participate in a CE. Remember that it is important to always cooperate with the demands of the hearing. Typically, that CE is requested based on a need for further information relative to your case. It is not requested in order to deny you the SSDI benefits you deserve and need. The judge just needs further information so he or she can make the best decision possible.

Jonathan Ginsberg has been practicing Social Security Disability law in the Atlanta, Georgia area for over 20 years. His website can be found at www.atlantasocialsecuritydisabilityattorney.net

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