MEDICAL CONSULTATIVE EXAMS

When Social Security doesn't have enough medical evidence to make a decision on a disability case, they usually order a consultative examination.  The claimant will be sent to a doctor who is in private practice but performs Social Security examinations under contract (for a fee).  My experience has been that in about 90 percent of cases, the consultative examination will not support a disability claim.  There are several factors involved, which I will state briefly (in my opinion).

• The doctor has never seen the patient before. This is their first meeting.
• The doctor's time is very limited.  Some doctors spend as little as 15 minutes on a consultative exam.
• The doctor may have a conflict of interest since he/she is being paid by Social Security, not by the claimant.
• The doctor may only be looking for obvious signs of disability which cannot be discerned in a brief examination with no X-rays, lab tests or other diagnostic support.
• The doctor will not listen to the claimant; he wants to cover the required bases, finish the exam, bill Social Security and get on to his waiting room full of patients.

So in a majority of cases, the doctor performing the consultative examination will provide evidence that the claimant does not have serious impairments.  At least, Social Security will interpret the doctor's findings to mean that. The result is usually a denial of benefits.  What can you do?

Even Social Security regulations stipulate that a consultative examination by the patient's own treating physician is preferred.  If at all possible, the claimant should try to get his/her own doctor to perform the exam.  I am surprised, however, at how many treating physicians refuse to conduct an examination of their own patients for Social Security.  This is because of the relatively low fees that Social Security is willing to pay for an exam.

My best advice is, ask your doctor if he or she will perform your exam.  (You can't leave it up to Social Security to do that--because they won't; they will send you to the next doctor on their rotation and you never know who that will be).  If you are represented, your advocate or attorney should try to get the exam performed by your own doctor.  The excuse we often get, however, is "The claimant's doctor refuses to perform the exam."

So you go to a doctor you've never seen before and he says that because you're breathing you are not disabled.  Social Security accepts that without question (99 percent of the time) and you get denied.  What do you do?  You kick it up to the next level, an appeal hearing, where the judge is not bound to pay much attention to the consultative exam and is more likely to consider all the evidence, including the opinion of your treating doctors.

The claimant is always better off when he/she has a good relationship with a treating doctor.  It is always to the claimant's advantage to have any requested consultative examination performed by that treating doctor.  You have to be assertive to make that happen.