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Social Security Disability & SSI: The Consultative Exam

26ad151466cb46bda372f2f77825c707.jpgAfter you apply for benefits, your claim will be assigned to a case worker at your local SSA district office. The work is divided between the case workers by program type (SSI or SSDI) and by the first letter of the claimant's last name. Once your case worker processes your application, your claim will be forwarded to Disability Determination Services, or 'DDS.' It can take anywhere from a couple weeks to around 6 months for your claim to be forwarded; the application speed of individual district offices varies significantly.

Once your claim is forwarded to DDS, it will be assigned to a claims examiner. This individual is not a doctor, so they cannot make a medical decision on your claim themselves. Rather, the claims examiner's job is to determine whether or not there is sufficient information for your claim to be forwarded to SSA's doctors so that they can make a decision.

If the claims examiner believes that, between your medical records and the forms you have filled out and returned to their office, there is still not enough information to make a decision on your claim, then they can set up an appointment for you to attend a consultative exam. The purpose of this exam is ostensibly to supplement the information already submitted in regard to your claim so that SSA's doctors can make a decision.

Unfortunately, these exams are often extremely cursory; there are many anecdotal accounts of individuals with internal conditions only going to a consultative exam and merely being asked a series of questions rather than being asked to submit to any medical tests. The reality is that consultative exams are contracted by the government via a formalized bidding process. Sadly, this means that the quality of these exams is sometimes quite low. On top of that, the fact that the claims examiner has requested a CE (consultative exam) at all means that they believe that there was not enough information to approve (or deny) your claim, which means that you are relying on what is often a highly cursory exam to get your claim approved.

However, the fact is that some clients are approved after CE's because some CE's are conducted thoroughly and carefully. Most importantly, if you do not attend your CE, a judge can order you to attend one later in the application process, which can delay a favorable decision and may even prevent it if you do not attend the CE. If you would like to discuss your CE in greater detail, please do not hesitate to contact our office.

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