If you have applied for Social Security Disability Insurance (SSDI) benefits and received a notice for a consultative examination, you might feel confused or concerned about what this means for your claim. A consultative exam is simply a medical or psychological evaluation requested by the Social Security Administration when they need more information to make a decision about your disability status.
At Sigman Janssen, our experienced SSDI attorneys in Appleton understand the stress and uncertainty that comes with navigating the disability claims process. We have guided countless Wisconsin residents through consultative examinations and the entire SSDI application journey. Our team is deeply committed to helping you understand what to expect and how to approach your consultative exam to strengthen your disability claim.
Request a free review of your SSDI case today. (920) 335-1394
What Is a Consultative Exam for SSDI?
A consultative exam (CE) is a medical or psychological examination arranged and paid for by the Social Security Administration (SSA). The SSA may request a consultative exam when they need additional medical evidence to help them determine whether an applicant qualifies for SSDI benefits.
A CE typically only lasts about 30-60 minutes, and they focus specifically on verifying the medical conditions listed in your disability application.
The SSA may request one of these different types of consultative exams depending on your claimed disability:
- Physical Examinations: A physical CE may be requested when the SSA needs an assessment of your physical limitations, mobility, strength, and other bodily functions relevant to your claimed disability/
- Mental Health Evaluations: A CE that will help the SSA determine your psychological condition, cognitive abilities, and mental functioning.
- Specialized Tests: Other focused CEs may include vision tests, hearing evaluations, pulmonary function tests, or other specific medical assessments related to your condition.
The consultative exam is not intended to provide treatment but rather to document your current medical status for evaluation purposes.
Why Did Social Security Request a Consultative Exam for My Disability Claim?
The SSA may request a CE for several legitimate reasons, none of which necessarily indicates a problem with your application. Legitimate reasons you may be asked to get a consultative exam includes the following:
- There Is Insufficient Medical Evidence to Support Your Claim: Your current medical records may not provide enough detail about how your condition limits your ability to work.
- The Medical Information Provided Is Outdated: The SSA needs current medical documentation, generally from within the past 90 days.
- You Have Gaps in Your Treatment History: If you have not seen a doctor recently for your condition, the SSA needs updated information.
- You May Need a Specialized Assessment: Your disability might require an evaluation by a specialist not listed in your current medical records.
- There Are Conflicting Medical Opinions: Different doctors may have provided contradictory information about your condition.
The primary goal of these exams is to gather objective medical evidence to support a fair decision about your disability status, not to find reasons to deny your claim.
Does Being Sent for a Consultative Exam Mean My Claim Will Be Denied?
Many Appleton SSDI applicants may worry that being scheduled for a consultative exam signals an impending denial. While this concern is understandable, getting a request for a CE does not predict the outcome of your disability application. Consultative exams could help to strengthen your claim by providing the additional medical evidence you need.
What Happens During a Consultative Examination?
A CE follows a structured format to ensure the outcome provides specific information about your medical condition and functional limitations. The process varies slightly depending on whether you are having a physical or mental health evaluation.
Physical Consultative Exams
During a physical consultative exam, you can expect:
- Medical History Review: The doctor will discuss your conditions, symptoms, treatments, and medications.
- Focused Physical Examination: The doctor will examine body systems related to your claimed disability.
- Range of Motion Test: Measurements of how well your joints move may be taken and documented.
- Strength and Coordination Assessment: Basic tests of muscle strength, reflexes, and physical abilities.
- Specialized Testing: Depending on your condition, additional tests like breathing assessments or neurological evaluations.
Mental Health Consultative Exams
For psychological or cognitive evaluations, the process typically includes:
- Clinical interview: Discussion of your mental health history, symptoms, and treatments.
- Cognitive testing: Assessments of memory, concentration, problem-solving, and other mental functions.
- Psychological screening: Evaluation of mood, behavior, and thought processes.
- Functional assessment: Questions about your daily activities and how your condition affects them.
Most consultative exams last between 15 minutes and an hour. The doctor will submit a detailed report to the SSA within 10 business days of your appointment.
How Do I Prepare for My Consultative Exam in Wisconsin?
There are a few things you need to bring for your consultative exam in Wisconsin. Being prepared for your exam can significantly impact the quality of information collected about your disability. The following strategies will help you present an accurate picture of your condition.
Before your exam, gather and review these important items:
- Medical Documentation: Bring copies of recent medical records that the consultative examiner might not have received.
- Medication List: Prepare a complete list of all medications, including dosages and schedules.
- Symptom Journal: Document your symptoms, their frequency, and how they affect your daily activities.
- Assistive Devices: If you regularly use a cane, braces, oxygen or other medical assistive devices, be sure to bring them with you.
- Photo ID and Appointment Notice: These documents will be required when you check-in to your appointment.
Your behavior and communication during the exam also matter:
- Honest reporting: Be truthful about your symptoms without exaggeration or minimization.
- Specific examples: Describe how your condition limits your activities with concrete examples.
- Clear communication: Explain the good days and bad days associated with your condition.
- Complete answers: Respond to all questions thoroughly, even if they seem repetitive.
The Wisconsin disability determination process values consistency between your reported limitations and objective medical findings. Your preparation helps ensure this consistency comes through in your consultative exam report.
Common Myths About SSDI Consultative Exams in Appleton, Wisconsin
Misinformation about consultative exams causes unnecessary stress for many Appleton residents applying for disability benefits. These examinations are surrounded by several persistent myths that deserve correction.
The following misconceptions about consultative exams frequently circulate among SSDI applicants:
- The Exam Means Your Claim Will Be Denied: There are multiple reasons your claim could be denied. However, the objective medical evidence from a CE often supports legitimate disability claims.
- Exams Only Last Five Minutes: While some exams are brief, most last 15-60 minutes depending on the condition being evaluated.
- The Doctor Is Paid to Deny Your Claim: Consultative examiners receive the same payment regardless of their findings and have no financial incentive to provide negative reports.
- You Should Perform Your Worst During the Exam: Dishonest exaggeration can damage your credibility and hurt your claim more than it helps.
- The Examining Doctor’s Opinion Is the Only Deciding Factor In Your Case: The CE report is just one piece of evidence. The findings from this exam will be considered alongside your medical records, work history, and other factors.
Social Security’s disability evaluation process in Wisconsin follows standardized criteria. The consultative exam provides one source of medical evidence within this larger framework.
How Consultative Exam Results Affect Your SSDI Decision
The consultative examination produces a detailed report that significantly impacts your disability claim. This report becomes a key piece of evidence in determining your eligibility for benefits.
What Is in the Report
After examining you, the doctor creates a comprehensive document that includes:
- Clinical Findings: Medical observations made during your examination
- Laboratory Results: Test results from your appointment
- Diagnosis: The doctor’s assessment of your medical condition
- Prognosis: How your condition is expected to progress over time
- Functional Assessment: How your condition limits your ability to work
How the SSA Uses This Information
Disability Determination Services reviews this report alongside your other medical evidence to:
- Compare findings with your treating doctors’ records
- Complete your Residual Functional Capacity (RFC) assessment
- Determine if your condition meets disability listing requirements
- Evaluate whether you can perform your past work or any other jobs
The impact of this report depends on its thoroughness, the examiner’s expertise, and how well it aligns with your existing medical records. When contradictions exist between the CE report and your regular medical documentation, Social Security must explain which evidence they found more persuasive and why.
What If the CE Report Does Not Accurately Reflect Your Disability?
Consultative exam reports sometimes fail to capture your full disability due to several factors. Some of the most common reasons include the following:
- Brief appointments may not allow time to evaluate complex conditions thoroughly.
- Examiners might not have access to your full medical history or specialized knowledge about your condition.
- Your symptoms may have temporarily improved on exam day
- Communication barriers might have prevented you from fully explaining your limitations.
If your exam results seem inaccurate, you will need to take prompt action to protect your claim.
Need Help With Your SSDI Claim? Call Sigman Janssen Today
Navigating the SSDI application process while managing a disability can be overwhelming. Working with an attorney who can guide you throughout the application process means you have someone guiding you throughout the process, giving your claim an optimal chance of succeeding.
At Sigman Janssen, we have been helping SSDI applicants with their applications for decades. We have extensive knowledge of what the SSA needs to give a fair review of your case, and we can help you avoid mistakes many applicants make.
Take advantage of our SSDI by calling our Appleton law office for a free case review. We can answer your questions and evaluate your situation. If we take on your case, we can develop a strategic approach to strengthening your SSDI claim.
Call our trusted law firm to find out how we can help. (920) 335-1394