For North Carolina residents who are ill or injured, Social Security disability benefits are vital to their everyday survival. When applying for SSD benefits, it is necessary to meet certain medical requirements in order to be approved. In some instances, however, the case cannot be decided based on the initial medical information that the claimant provides. If this occurs, it will be necessary to have a consultative examination (CE). It is important to understand the details of this examination, as it can play a crucial role in the outcome of a claim adjudication.
If the initial medical examination is not sufficient, the medical source might be contacted to get more information, or the CE will be required. In general, the Social Security Administration prefers to use the initial medical source’s findings to come to a decision. However, if the CE is needed, the SSA will pay for it.
The SSA can also use an independent medical source for the CE. There are certain situations in which this will take place. For example, a claimant’s medical source might not want to conduct the examination, the medical source might not have the required equipment to gather the data that the SSA needs, there could be issues in the file that the original medical source cannot handle, the SSA might have knowledge regarding the medical source and does not believe that the opinion will be useful, or the medical source the claimant is using might not have the necessary qualifications.
It can be worrisome for an applicant to be asked to take a CE after providing the requested information from a medical source, but it does not necessarily mean that the claim will be denied. For people who are seeking SSD benefits, there are a litany of issues that can arise during the process, whether it is the initial medical examination, the CE, or something else. Having a lawyer who is experienced with Social Security disability to help is an important step in any circumstance.
Source: Social Security Administration, “Disability Evaluation Under Social Security — Consultative Examinations,” accessed on July 29, 2017
"*" indicates required fields