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

If you’re applying for disability, you may need to take a consultative examination to provide the Social Security Administration (SSA) with additional information about your condition. This exam helps the SSA determine your eligibility for benefits. We’ll break down the consultative exam and other information so it goes as smoothly as possible.

What is a consultative exam?

A consultative exam (CE) is a medical exam or test to determine whether your health condition meets the SSA’s definition of disability. The SSA may request a general physical exam, a psychological evaluation, or a specific test, like an X-ray. The CE appointment happens after you submit your disability application, though the exact timing varies. 

Does everyone need a consultative exam?

Almost every Social Security disability applicant will need a consultative exam. Disability Determination Services (DDS), which handles medical evaluations for the SSA, will send claimants a letter with the appointment's date, time, and location.

5 reasons you may need a consultative exam

When you apply for disability benefits, the Disability Determination Services collects medical records from your doctors. You may need a consultative exam if:

1. Your health records do not provide clear evidence of a professional diagnosing you with the reported condition.

2. DDS needs more detailed information about the severity of your impairment.

3. There are inconsistencies in your medical history, like conflicting results from your doctors.

4. The information in your benefits application does not clearly demonstrate that your condition prevents you from working.

5. Your medical records do not address specific technical or specialized requirements, so DDS can't prove your condition meets the SSA’s definition of disability.

Need help improving your medical records? The best option is to work with a disability lawyer. They’re experts in the disability process and can advise you on strengthening your claim. Applicants with lawyers are also three times more likely to win benefits.

Learn more about how disability lawyers can help with your disability benefits application.

Is a consultative exam good or bad?

If the SSA requests a consultative exam, it is not necessarily a good or bad sign for your disability claim. A CE may be necessary if your medical records are insufficient for Social Security to determine your application. While consultative exams can sometimes provide the required information about your condition, they may not always suffice.

Typically, a CE is not comprehensive, so it should not be your primary source of medical records. It is important to continue seeing your treating physician to have other medical records to supplement the CE results.

For help, start with our guide on how to work with your doctor for disability.

What happens during the consultative exam?

The consultative exam differs based on conditions and typically lasts 30-60 minutes. In most cases, you will receive a physical or psychological exam. You might also need specific imaging or laboratory tests, such as an EKG, X-ray, or bloodwork.

The disability examiner will only perform the exam the SSA requests for your application. The examiner will not do not anything extra, and you won’t be able to ask them for tests that you think would help your claim.

Be completely honest about your condition and how you’re managing it. Tell the doctor what symptoms you’ve been experiencing and answer based on how you feel on your worst days — even if you feel good on that specific day.

Who performs the consultative exam?

Usually, the SSA will contract an independent doctor, physician, or psychologist to perform the consultative exam. It is unlikely that your treating physician will agree to do the CE because of the SSA’s timing restrictions and set fee for services. 

Lawyer tip: It may be a good idea to see your own doctor around the time of the consultative exam. If your disability claim is denied and you need to challenge the examiner’s findings, having more detailed results from your own doctor could help.

It is best to comply with the SSA’s request for the exam with a contracted physician and continue to see your doctor to strengthen your medical records. 

How long does it take for a decision after a Social Security consultative exam?

After the exam, the doctor fills out a report with their findings. They send that report to DDS and Social Security, and the CE report becomes part of the medical evidence in your claim file.

After the exam, it could still take several months for you to hear back on a decision for your application. Unfortunately, the consultative exam is only one step of the process, and getting approved for disability can take two years after initial application.

Who pays for the consultative exam?

The SSA will cover the cost of the consultative exam. The SSA will also cover the cost of an interpreter for the exam, should you need one. In some cases, the SSA will cover transportation costs to and from the appointment.

What happens if I miss the consultative exam?

Attending your consultative exam is crucial. Missing the CE appointment can prolong your application, and the SSA will sometimes decide on your case based on the information in your application and existing medical records. 

If you miss your consultative exam, the first thing to do is to call your disability lawyer. If you don’t have an attorney, call your examiner with a good excuse and ask them to reschedule the appointment. 

Get help from a disability lawyer

A Social Security disability lawyer understands the application process and can help you secure the medical records necessary for your condition. 

If the results of your consultative exam are insufficient and the SSA denies your claim, a good disability lawyer will know the best way to challenge the results and convince a judge of your eligibility during an appeal.

If you are applying for disability benefits, take our 2-minute disability quiz to see if you may qualify. A member of our team can offer you advice on your disability case and connect you with a disability lawyer if you’d like, for no upfront cost.

Related resources:

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

By Jackie Jakab

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

By Sydney Hershenhorn