Is a Consultative Exam a Good or Bad Sign for Your Disability Application?

After submitting your application, the Social Security Administration may send you a letter requesting a consultative exam to learn more about your condition. Consultative exams are a common source of stress for Social Security disability applicants, but they’re a regular part of the process. We’ll break down what to expect at a consultative exam and how to best prepare.

What is a consultative exam?

A consultative exam (CE) is a physical or mental examination medical with a doctor contracted by the Social Security Administration (SSA). The exam might be a general physical exam or include specific tests, bloodwork, or X-rays. Consultative exams are common whether you apply for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).

Why would the SSA request a consultative exam?

The SSA requests a consultative exam if the medical information from your application isn’t enough to decide on your disability claim. More specifically, your exam is set up by Disability Determinations Services (DDS), which helps the SSA with disability claims by handling the review of applicants’ medical evidence.

Sometimes, the SSA doesn’t have enough proof that you have the medical condition you claim to have on your application. There may also be inconsistencies in your medical history, or the SSA wants more detailed information about your condition.

Regardless, the disability doctor will likely ask about your functionality or how you handle certain daily activities. Specific tests — like blood work — may also be necessary to show you meet certain technical requirements for your condition.

Who pays for a consultative exam?

The SSA will cover the costs of the consultative examination, including significant travel costs, if required. The SSA will also pay for a translator for the appointment, if necessary.

Is a consultative exam good or bad for your disability application?

A consultative exam isn’t necessarily a good or bad sign for your disability application.If you need a consultative exam, the SSA believes that the medical information in your application isn’t enough to make a decision on approving your benefits. And since the exams are usually quick and not very thorough, they’re unlikely to result in new information that will help your case. It’s very important that you don’t look at your consultative exam as your main source of medical evidence. Your goal when applying should be to already have clear medical records of your disability. Then, the consultative exam will only be needed to confirm your claims, if it’s needed at all.

Here are some signs you’ll be approved for disability.

Can I refuse a consultative exam?

Consultative exams are not mandatory, but if you refuse to undergo a consultative exam, the DDS will likely reject your disability claim. If you miss the appointment, the SSA will rely on the information in your application, which they have already indicated isn’t enough for them to make a clear decision.

Instead of refusing the exam, you may want to schedule a visit with your personal doctor around the same time as your exam with the disability doctor. That way, if the consultative examiner determines you don’t qualify for benefits, your doctor’s findings from the same time may help convince the SSA or a judge that you do qualify.

What happens if I miss the consultative exam?

If you miss your consultative exam, call your disability lawyer right away. If you do not have a disability attorney, call your medical examiner with a good excuse for your absence and request to reschedule the appointment. Sometimes, the appointment will be rescheduled, but the SSA may make a decision about your disability claim with your existing medical records.

What to expect at a consultative exam

Consultative exams generally work like a basic physical or mental examination. The SSA will send you a letter outlining the necessary tests and appointment date.

If you list anemia on your disability application, the SSA may request an exam where the doctor does blood work or checks for physical symptoms of anemia. If you have back pain, you may meet with a physician who tests your mobility and asks questions about your pain to understand its severity. If you’re applying with anxiety, your exam may involve a psychologist asking questions to help confirm whether you exhibit common symptoms of anxiety.

How long is a consultative exam?

It’s important to remember that these exams are usually quick — maybe 15 to 20 minutes — and not very thorough. They may feel awkward because you’re meeting a new doctor. Don’t feel discouraged if the doctor doesn’t talk much or if you don’t connect with them in your short meeting.

How to pass a consultative exam

You should follow the same basic guidelines at your consultative exam that you would for any doctor visit:

• Answer based on your worst or average days. When describing your symptoms and health conditions, describe how they affect you on average or even on your worst days — even if you feel good at the actual time of the exam.

• Be specific. Avoid vague answers, or the doctor may assume you can do more than you can. Instead of saying you can’t stand for long, say you can stand for 10 to 15 minutes before you need to sit down.

• Talk about your struggles. The exam is your chance to complain. The doctor needs to know how your disability affects your ability to work and handle daily activities. Be completely honest and make it clear that you’ve had to adjust your life because of your health condition.

What happens after a consultative exam for Social Security?

The doctor who performs your consultative exam will complete a report with their findings and send it to the SSA to become part of your application file. You can also request that they send the results to your doctor.

Next, the SSA will make a decision to approve or deny your application based on the results of your exam and the rest of your file, and you should receive a notification two weeks after your consultative exam.

If your application is denied, you can appeal the decision. At this stage, your odds of winning benefits are much higher if you have a disability lawyer to help you. A Social Security disability lawyer is experienced in reading CE reports and will challenge the CE doctor’s findings if necessary.

Get help with your disability application

A disability lawyer can help you at every stage of the disability application process, including the consultative exam. A lawyer can help you prepare for a CE and challenge the examiner’s report if necessary.

A Social Security disability lawyer can give you personalized guidance on your application and help you build a strong case that the SSA is more likely to approve. Claimants with a disability lawyer are three times more likely to win benefits.

Start with our 2-minute Social Security disability quiz. One of our team members will be in touch to learn more about your disability case and offer advice. Atticus can match you with a lawyer if you’re interested. There are no upfront costs — you only pay your lawyer a one-time fee when they win you benefits.

Related resources:

Ask Atticus: How Do I Know if My Consultative Exam Went Well?

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What Is a Consultative Exam? What to Expect at a CE

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