SSD: What You Need to Know Before Your Consultative Exam

consultative exam

If you apply for Social Security disability (SSD) benefits, you may get a letter from the SSA. This letter likely tells you the SSA scheduled your consultative exam with a Disability Determination Services (DDS) medical examiner. But don’t worry! We’ll explain how to prepare, what to expect and share tips to help you pass in our FAQs below.



FAQ #1: “Why Do I Have A Consultative Exam Scheduled With Some DDS Doctor?”

Unless you obviously meet the Social Security Administration’s definition of disabled, DDS always requires a consultative exam. (Think: You recently lost two limbs in a car accident or got stage 4 pancreatic cancer.) The SSA sets up this medical exam to verify your condition meets their own disability guidelines. Another reason you may need a consultative exam? Because you didn’t submit clear and convincing medical evidence required to support your disability claim. Finally, when’s the last time you saw your doctor? If it was more than 90 days ago, the SSA can’t approve your claim without a consultative exam.

FAQ #2: “What Happens If I Can’t Make It To My Consultative Exam?”

If you get a consultative exam request from the SSA, the worst thing you can do is ignore it. Many people might think a consultative exam isn’t that important. However, that letter shows the SSA’s reviewing your claim and needs more evidence before they can approve it. Skipping your appointment tells the SSA you’re not willing to do what it takes to get approved for benefits. To them, it means you’re either avoiding the consultative exam or your disability already improved enough for you to start working again. We know things like bad weather, no way to get there or serious illness can force you to miss your appointment. The good news: You can reschedule your consultative exam if needed (as long as you call far enough in advance). The sooner you get your consultative exam over with, the better! If you skip it and don’t reschedule, they’ll almost certainly deny your claim.

FAQ #3: “Will This Consultative Exam Cost Me Money?”

Nope, the SSA pays for it. You’ll owe no money at all (unless you pay for transportation to get there). And the SSA should pay you back any qualified travel costs for getting to and from your consultative exam.

FAQ #4: “Can My Own Doctor Do This Consultative Exam For Me?”

Almost certainly not. The SSA updated their medical evidence rules for disability claims on March 27, 2017. That rule says the SSA must respect your one-time consultative exam doctor’s assessment more than your own physician’s opinion. In other words, if your doctor says you’re disabled but your DDS physician disagrees, the second opinion wins. So, again, it’s really important to show up to your scheduled consultative exam on time and be prepared. The doctor you see won’t know your medical history, but may perform some laboratory tests. Just try to relax and follow the doctor’s instructions.

FAQ #5: “How Long Does This Exam Usually Take?”

The appointment’s usually pretty short, lasting around 10 to 15 minutes. But if your consultative exam is to confirm a mental health issue, it may last up to four hours. This means your exam will only include tests the SSA ordered directly to support your disability claim. In other words, they may fall short in determining your condition’s physical or psychological limitations. Remember, the DDS examiner’s just trying to get acceptable medical evidence the SSA requested while reviewing your claim. This isn’t about treating your condition, or proving you’re sicker or worse off than anyone else.

FAQ #6: “What Else Should I Know Before Going In?”

The DDS examiner won’t know you personally, and neither will the nursing staff. But these people will start watching you the second you arrive for your consultative exam. Observation starts the moment you step off your bus, out of your car or into the waiting room for your appointment. Anything they see may possibly hurt or help your disability claim, so be aware of everything you do and say around them. Here are a few more things to keep in mind:

  1. Do not exaggerate or minimize your symptoms. Your best bet is to get this consultative exam over with quickly. Talk only about how your condition limits your ability to work and avoid asking the DDS doctor too many questions. This person has a specific job and a short time to do it, so dragging things out only hurts your case.
  2. Make your answers short, direct and to the point. Nervous people often ramble on too long or get emotional discussing health problems with strangers. If that describes you, please complete #3 before you arrive!
  3. One week before your exam, write down all your current symptoms and how often they affect your daily life. Give yourself all seven days to finish this list and add or delete things that don’t affect you regularly. Some things that may help prove your case: Can you prepare food for yourself daily without help? Are you able to stand, sit, climb up or down a few stairs and walk 10 steps in a straight line on your own? If you drop a pencil on the ground, can you stoop down and pick it back up? If not, tell (or show) your DDS examiner!
  4. Bring copies of all medical records from your treating healthcare providers with you, if possible. These should cover your condition’s last 12 months of treatments from all doctors prior to your consultative exam. You don’t have to go over these in detail at your appointment. You just want to ensure that the DDS examiner and the SSA have the most current medical records available for reviewing your case.

FAQ #7: “Does the Consultative Exam Doctor Approve or Deny My Disability Claim?”

Once your exam’s over, the DDS examiner submits a detailed medical report to the SSA. This report will include your assessment along with any laboratory test results. The SSA will then review these and your most recent medical records (along with any notes from your consultative exam doctor). Once that’s done, Disability Determination Services will either approve or deny your benefits application.

You May Qualify for Legal Assistance

If the DDS claims examiner denies your application, you can always appeal that decision within 60 days. The best way to avoid that problem is getting a Social Security attorney to help file your claim. Already applied and got a denial letter in the mail? You can get a lawyer to review your benefits application for mistakes free of charge. These lawyers always work on contingency, so you’ll pay nothing for professional help unless they help you win benefits. And if your case wins, you’ll only pay a small, one-time fee.

Ready to see if you may qualify? Click the button below to start your free online benefits evaluation now!

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