Many Social Security Disability claimants worry that being scheduled for a Consultative Exam (CE) is a sign that their claim will be denied. While it’s true that some claims are denied after a CE, it’s important to understand that a CE does not automatically lead to a denial. In fact, the outcome of your claim depends on a variety of factors, including the quality of your medical evidence, your cooperation during the exam, and how well your symptoms are documented.
Here’s a closer look at how CE exams are used in disability claims and what you can do to ensure your exam supports your case.
Why SSA Orders Consultative Exams
SSA orders a CE when they need more information to evaluate your disability claim. This can happen for a variety of reasons, such as:
- Incomplete or outdated medical records: If your medical records don’t provide enough detail about your condition, SSA may order a CE to gather additional information.
- Conflicting medical opinions: If your treating doctor’s opinion contradicts other evidence in your case, SSA may schedule a CE to clarify your functional limitations.
- Lack of recent treatment: If you haven’t seen a doctor in a while, SSA may request a CE to determine the current severity of your condition.
The purpose of the CE is to provide SSA with a clearer picture of your functional limitations and how your symptoms affect your ability to work. A well-documented CE can help support your claim, especially if it aligns with your medical records.
Do CE Exams Typically Lead to Denials?
While some claims are denied after a CE, it’s not a foregone conclusion. The outcome of your CE depends on several factors, including:
- The quality of your medical records: If your medical records are complete, detailed, and up-to-date, the CE may simply confirm the information you’ve already provided, leading to an approval.
- Your cooperation during the exam: How you present yourself during the CE matters. Being honest, cooperative, and forthcoming about your symptoms can help the CE doctor provide an accurate assessment of your condition.
- The doctor’s findings: If the CE doctor’s report supports the severity of your condition, it can strengthen your case. However, if the doctor’s findings contradict your medical records, it could result in a denial.
The key to a successful CE is ensuring that your medical records are complete and that you’re prepared to explain your symptoms clearly during the exam.
What You Can Do to Strengthen Your Case
- Ensure your medical records are complete: Before attending the CE, make sure your medical records are up-to-date and include detailed information about your symptoms, treatments, and functional limitations. This will give the CE doctor a clearer understanding of your condition.
- Communicate clearly: During the exam, be honest about your symptoms and how they affect your daily life. If you experience good days and bad days, explain the differences and how frequently you experience flare-ups or worsening symptoms.
- Follow up with SSA: After the exam, follow up with SSA to ensure they’ve received the CE doctor’s report. If there are discrepancies between the report and your medical records, you may need to provide additional evidence or seek clarification from your treating doctor.
Common Mistakes to Avoid
- Exaggerating or minimizing symptoms: Some claimants feel the need to exaggerate their symptoms during the CE to strengthen their case, but this can backfire if the doctor feels you’re not being truthful. On the other hand, downplaying your symptoms can also hurt your claim. Be honest and provide clear, accurate descriptions of your limitations.
- Missing the exam: Failure to attend the CE can result in an automatic denial. If you’re unable to attend your scheduled exam, contact SSA immediately to reschedule.
How an Attorney Can Help
A Consultative Exam can feel like a pivotal moment in your disability claim, but it’s important to remember that it’s just one piece of the puzzle. An experienced disability attorney can help you prepare for the CE, ensure your medical records are complete, and address any concerns you may have about the exam process.
At Disability Law Group, we understand how to navigate the CE process and can help ensure your claim remains strong. Contact us today if you’ve been scheduled for a Consultative Exam and want expert guidance to maximize your chances of success.
