CONSULTATIVE EXAM TIPS – Medical Evidence Wins Your Benefits

WHAT IS A CONSULTATIVE EXAM?

After you apply for Social Security Disability benefits or Supplemental Security Income benefits, you may receive a notice in the mail. This notice schedules you for a Consultative Exam.  The SSA usually schedules an exam with one of their doctors during the first six months of the appeals process. For example, they will usually schedule a doctor exam for you during the initial or second appeal stage of your case.

Typically, a physical or mental exam with a doctor is scheduled because the SSA feels they need more medical evidence. They will use the medical evidence to decide whether or not you are eligible for SSDI and SSI benefits. If you need more information about your consultative exam, then contact our SSD law firm.

Under Social Security law, physical and mental conditions can only qualify for benefits if an acceptable medical source states you have the condition. An acceptable medical source is usually a doctor with an M.D. or a Ph.D..

There are some treating providers that the SSA does not consider to be acceptable medical sources. However, the SSA will consider  the medical opinion of physician assistants, nurse practitioners, social workers, counselors, and physical therapists.

Therefore, if you are seeing a social worker for mental conditions, submit the records. Or, if you are seeing a physical therapist for back pain, you should submit those records. Find out how to collect and submit your medical records to the SSA.

THE SSA WILL SCHEDULE YOU FOR A CONSULTATIVE EXAM

When you are at the appeal levels of your case, the SSA may decide to schedule you for a free doctor exam with one of their doctors. You need to go to the exam.

If you don’t go, then the SSA will deny your case. You don’t want that to happen. Use the exam to tell the doctor what physical and mental conditions are making it impossible for you to do full time work. For example, if you have liver cancer or breast cancer, or any other disease, then bring your medical records to the exam so the doctor can review them. Don’t rely on the SSA to send your records. Because they usually don’t.

The SSA will send you a written notice in the mail. It will have the name of the doctor, the address you need to go to, and the date and time of the exam.

If you cannot attend the exam, then you must call the SSA to inform them that you have a conflict. Usually, they will set a new appointment time for you, so you can attend. Whatever you do, do not miss the exam. They will not give you a new exam time if you miss it without explanation.

WHAT HAPPENS WITH THE WRITTEN DOCTOR’S REPORT?

Once you have gone to the exam, the doctor will write a report about you. Then the doctor will submit the report to the SSA. You will not receive a copy of the report in the mail. So, you will not know what it says.

However, the report usually includes information about how your symptoms would affect you if you were working 40 hours a week. For example, if the doctor visit is for a physical condition, then the doctor will write about your ability to sit, stand, walk, and lift. If you need a copy of the exam, then you can obtain it after the SSA decides your claim.

You should take the exam seriously. If for any reason you cannot attend, then schedule a new time with the SSA. The SSA pays for the exam and will use the results to decide your case. But if you do not attend the exam, they will use your failure to attend to deny your claim.

WHY DOES THE SSA SEND YOU TO A CONSULTATIVE EXAM?

The SSA is sending you to an exam with a doctor or a psychologist to document your medical condition. Therefore, it is crucial that you attend the exam. The doctor will be testing for physical conditions.

For example, if you have a back condition, then the doctor will be watching how you walk into the office. Likewise, they will watch you in the waiting room to see if you demonstrate pain behavior. The doctor will write about whether or not you can get up onto the exam table. They will also write about your ability to walk across the room without a cane. Or, they will state that you stood on the scale and could see your weight.

In the report to the SSA, the doctor will discuss how you move, bend, sit, stand, and walk. They will write down if you are able to get onto the exam table. The doctor will also write down your complaints and document those symptoms on exam.

THE MENTAL EXAM

At a mental exam, you visit the psychologist. The psychologist will interview you to see if you suffer from Anxiety, PTSD, or another mental condition. You may also be given an IQ test. Find out information about the WAIS IV IQ test.

Additionally, learn about benefits for Depression. Anxiety can also qualify you for SSDI and SSI benefits. Likewise, find out information about PTSD.

You should see the exam as an opportunity to explain your mental problems. You should tell the doctor how your symptoms affect you on a daily basis. For example, if you are depressed, then you could discuss how you can’t sleep at night. You could also talk about your panic attacks and how often they happen. Additionally, you could talk about being unable to concentrate. You should make sure to describe all of your mental issues with the doctor. Learn how to prepare for the psychological exam.

TIPS TO HELP YOU DURING YOUR CONSULTATIVE EXAM

Here are some tips to help you during your Consultative Exam. The SSA pays the doctor who is doing your exam. The doctor at the exam is not your doctor. The doctor is not on your side. You should not assume they are in support of you winning benefits.

If you are sent to an exam for physical conditions, you need to bring copies of your medical tests and records with you. Find out how to obtain a copy of your medical records.

For example, if you have an MRI, X-ray, CT scan, or a surgery, bring it with you to the exam. Give a copy of your records to the doctor. The reports provide medical evidence of your condition. Your medical records contain the medical opinion of your treating doctor about your ability to work. This opinion is good for the doctor to see.

Do not give the SSA doctor the original copy of your records. Also, do not assume the SSA will send your medical records to the doctor, because they usually don’t.  If you are scheduled for a physical exam, then bring your records to the doctor. The SSA is not going to send them. You have to explain all of your problems to the doctor.

EXPLAIN YOUR PAIN AND MENTAL SYMPTOMS AT THE CONSULTATIVE EXAM

The exam is your opportunity to describe your pain and how it limits you. If you do not tell the doctor what is wrong, there is no way for the doctor to explain your symptoms to the SSA. The same is true for a mental exam. If you see a psychologist, then tell them about your symptoms of low mood,  anxiety, or PTSD. Or, if you have any other mental condition, then explain your symptoms to the doctor.

Tell them if you have panic attacks from anxiety. Also, tell them about how you can’t concentrate and about your memory problems.  You should tell the doctor how your mental symptoms prevent you from doing your activities of daily living.  For example, if you have memory problems, you may forget to the pay your bills. Or, family members may need to remind you to do so. You may forget that your laundry is in the washing machine. Or, you might burn food that you cook in the oven.

If you have physical problems, then you may need help getting dressed. You might also need help doing laundry or cooking. If you have trouble walking and need a cane or walker, then bring it and use it at the exam. It is important to talk about and show your symptoms at the Consultative Exam.

AT THE CONSULTATIVE EXAM EXPLAIN TO THE DOCTOR WHY YOUR SYMPTOMS KEEP YOU FROM WORKING 

Typically, during a physical exam, the doctor will ask you how many pounds you can lift. Do not brag about your past strength. The doctor is asking how many pounds you can currently lift over and over again throughout the course of an 8 hour workday.

If you have back problems or joint pain, you will probably not be able to lift more than 10 pounds. Especially, when you are working over an eight hour period of time. Find out about arthritis. Learn about another form of the disease, osteoarthritis. Also, you can find out information if you have a back condition that keeps you from working.

Be realistic when you are answering questions from the doctor. And, explain to the doctor what symptoms are keeping you from working. Think about how difficult it would be for you to sit or stand during an eight hour workday.

MENTAL IMPAIRMENTS THAT PREVENT WORK

If you have mental issues, then think about how hard it might be for you to leave your home. Also, think about how hard it would be to deal with the public on the job. Would you lose your temper? Or, would you be rude to customers? Likewise, would you take too many breaks? Think about your ability to focus and concentrate during an 8 hour work day.

It is important to tell the doctor how your mental conditions affect you at work. For example, if you were fired from work, then tell the doctor. If you missed work due to your mental health problems, then let the doctor know. Other things you can talk about are being late to work or having to go home early. Or, not being able to follow instructions. Be able to answer the questions honestly. Doing so will help you be successful in winning your benefits.

If you have questions about what will happen at your SSA doctor exam, then call our law firm. We will help you prepare for your exam. Also, we can help you apply for SSD benefits and appeal a denial from the SSA. If you have an exam with the doctor, then bring your mental health records to the doctor for review.

DO YOU HAVE TO PAY FOR YOUR CONSULTATIVE EXAM?

No. You do not have to pay for the exam. It is free if the SSA schedules you to see on of their doctors. So, you will not have to pay to see the doctor. Likewise, you will not have to pay a co-pay or any money at the exam. Even if you are sent for a mental exam, you will not have to pay any fees to the doctor.

It is possible, if you have a rare disease, for the SSA to send you to an expert. Typically though, a request must be made in advance. Also, the expert must be available in the area where you live. Even if you have to visit an expert, you still will not have to pay for the exam.

When you attend the appointment, the SSA is paying for you to see the doctor. But you will not be having a private meeting with that doctor. In other words, it is not a private visit. Because, the doctor is sending a report to the SSA about you. If you have medical records, then bring them with you so the doctor can review them. If you need help with your Social Security claim, then contact our law firm.

AT THE CONSULTATIVE EXAM SHOW THE DOCTOR WHY YOU CANNOT WORK

The report written by the doctor will talk about how you act. Also, the doctor will report on the things you say and even what you are wearing. Some doctors also watch you as you walk into the building from the parking lot. Additionally, if you are rude to the front desk staff, that will go into the report too. They will even report on whether you are able to fill out the forms that they give you.

It is important to show the doctor your physical problems. For example, if you use a cane, then use it at the exam. Don’t leave it at home. If you use a walker, then use it at the exam.

The doctor will report on whether you are carrying a purse or a back pack. If you tell the doctor that you can only lift 10 pounds because of back pain, but you are carrying a large, full purse. Then what do you think the doctor will say in his report?

Other things the doctor will report on is how long you are able to sit during the exam. They will also report on whether you are able to easily get up onto the exam table. If you have pain, back problems, or trouble walking, then make sure you report it to the doctor. Also, make sure your actions support your words.

THE SSA USES THE EXAM TO DEFINE YOUR RESIDUAL FUNCTIONAL CAPACITY

In order to determine your RFC, the SSA looks to the medical evidence in your case. One of the pieces of medical information they will consider is the report from the SSA exam. The SSA gives a lot of weight to opinion of their own doctor. If your treating doctor has a different opinion to that of the SSA doctor, then the judge will take that into account.

Hiring a lawyer to help you get all of your medical records is a wise choice. The SSA stops getting the medical records in your case after they deny your case for the second time. This means that a year may go by without any collection of your records. Then, the SSA will set your hearing date. Learn how to obtain your medical evidence for free.

If you do not have an attorney helping you, then there will be no one getting your medical records while you await a hearing date. However, you must have medical records in order to prove a mental or physical condition before a judge.

Additionally, all of those medical records must be in to the judge more than one week prior to your hearing. If you submit medical records later, then the judge does not have to consider them. This is known as the 5 day rule. Learn about the 5 day rule for sending in medical evidence.

YOU ONLY PAY AN ATTORNEY FEE IF WE WIN YOUR CASE

Prior to your exam with the SSA doctor, you may need to hire an attorney. In order to hire our SSD law firm, all you need to do is contact us. We offer a free review of your case over the phone. And, it doesn’t cost anything to call us.

Better yet, it also doesn’t cost you any money to hire us. Why? Because you only pay us an attorney fee if we win your case. It means if we win your SSD case, then you pay out of your back benefits. If you do not win, then there is no attorney fee to pay. Our attorney fee is capped at $9200 or 25% of your back benefit. You pay whatever amount is less. If we do not win, then you do not owe an attorney fee.

However, if there are costs in your case, then you pay those. But usually those costs are less than $100 and consist of getting your medical records. Once we win, we are paid from your back benefit. But to hire most lawyers, you have to pay upfront. We don’t work like that. You don’t have a job. So, the only way to pay us is for us to win your SSD case. That is our goal. Call and see what we can do for you.

WHAT WE DO TO HELP YOU WIN SSDI AND SSI BENEFITS 

If you are sick, then you need help to apply for Social Security benefits. You can always call our law firm and we will help you. We can help you file your application. Also, we can help you appeal every SSA denial. For example, our attorneys and staff can:

• Send you the paperwork you need to become our client
• Help you file your application for SSDI and SSI benefits
• Inform the SSA they should pay your benefits under the Compassionate Allowance Rules
• Appeal if you receive an initial denial
• Help you confirm your SSA doctor exam
• Request a Hearing with an Administrative Law Judge
• Prepare you to testify at your SSA hearing
• Represent you at your hearing and question the expert witnesses
• Review information about job expert testimony
• Learn about medical expert testimony
• Request review of an SSA decision with the Appeals Council
• Request review of an Appeals Council denial in Federal Court

If you file your application for benefits online at Social Security’s website, then you have 6 months to complete it.  Do not take that long. Once you submit your application online, the SSA sends you an application summary in the mail. You must sign the summary and mail it back. If you don’t send it back, the SSA will not process your application. Sign it and send it back as soon as you can.

OUR LAWYERS AND STAFF CAN HELP YOU

If you want to learn about the lawyers at our law firm, then review our About Us page. For example, you may want to know that Dianna Cannon has been helping Social Security clients for thirty years. Brett Bunkall and Andria Summers have also won thousands of SSDI and SSI cases. We are can answer questions about what will happen at your consultative exam.

In the past 30 years, we have won over 20,000 SSDI and SSI cases for our clients. Our experts can help you apply for SSI and SSDI benefits using the SSA’s website. However, we will need your help to apply for SSI benefits. Why? Because only you know your personal financial information. SSI benefits require you to have minimal assets and monthly income.

Likewise, if you need an appeal, we can help you do that too. There are also many forms you will need to fill out. Don’t worry. If you have questions about these forms, then we will answer them. Learn about SSA’s appeal forms. Call us today.

We represent clients in many states, including Nevada, Utah, and Idaho. Find out about Nevada SSDI benefits. Learn about Utah SSD benefits and California SSDI and SSI benefits. No matter where you live, we want to be your legal team. Call us now. We will answer your questions about your consultative exam.