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Can a consultative exam help my Social Security Disability case?

On Behalf of | Jun 20, 2024 | Firm News

When New Jersey residents are seeking Social Security Disability benefits, the entire claim can come undone by one misstep or disagreement. Often, the case comes down to a medical assessment. Medical professionals are not always in lockstep when determining how severe a person’s injury, illness or condition is. This can sabotage even the strongest disability claim.

For some, the medical source chosen by the claimant is deemed insufficient by the Social Security Administration and its Disability Determination Services to make the final decision. In these instances, it may be necessary for a Consultative Examination. The claimant must be aware of what the CE entails and its importance. For disputes, it is essential to know the law and be protected to have a good chance at an approval or to take steps to appeal a denied claim.

Know the facts about a Consultative Examination

When a CE is required, it is essential to understand what it is and how it works. As a claimant, the person will provide evidence to prove they should get SSD benefits. When that evidence is not deemed sufficient to make a fair decision, a CE could provide more information or clarify lingering issues to help with the claim.

When the SSA decides on a claim, it will prefer to use the medical professional who treats the claimant. However, an independent CE can be used in certain circumstances. If, for example, the treating source does not want to perform the examination for any reason, that is a reason for a CE.

Another justification for a CE is if the file has a conflict or the report is not consistent and this cannot be addressed by returning to the treating physician. The claimant might simply want another source to assess them. They must give a good reason for it. The source that provided treatment might, for some reason, not be considered a good enough source to make an assessment.

With the CE, the needed evidence determines the extent of the testing. If MRIs, X-rays and other comprehensive testing is needed, then this is done on a case by case basis with Disability Determination Services needing to approve it before it can move forward. The CE must be a credentialed medical source.

Once the report is complete, it must cover all areas of the claimant’s case including their history, their current condition, if there are laboratory tests and what the CE concludes. When an independent reviewer looks at the case, they must be able to make an informed decision based on the evidence. Just as with any SSD case, that will include the claimant’s impairment, how long it will last and how severe it is.

Evidence is the foundation for a disability claim

When a person is seeking Social Security Disability benefits, there are bound to be obstacles large and small. For some, the case will be delayed due to issues with the medical evidence. Many might need to have a Consultative Examination to smooth the process to getting an approval.

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