We received this question from a reader: “I applied for Social Security disability. They sent me a letter saying I need an exam. Do I use my own doctor for this, or will they send me to a Social Security doctor? Thanks!”
The Social Security Administration (SSA) requires detailed, thorough medical records to evaluate a claim. This is true no matter who applies or what the circumstances are. If your application included every detail and strong medical evidence, then you may not need an exam. However, that’s not typical for most disability applicants. Most of the time, you’ll need to undergo a doctor’s exam in order to substantiate your SSD claim.
Is There Such a Thing as a Social Security Doctor?
The exam in the reader’s letter above is what the SSA calls a consultative exam. A consultative exam specifically evaluates your health to confirm it matches what you said in your SSD claim. The doctor who performs the exam will:
- Look for evidence that supports your SSD claim (or contradicts it). This may include running tests, having you answer some questions, ordering x-rays/MRI or CT scans, etc.
- Document whether your condition, illness, or injury might prevent you from working like you normally would. This includes listing reasons why you can’t perform your normal job duties full-time or do other work.
This is not an exam that your family doctor can likely perform. Why? Because the SSA must certify a doctor to perform that specific exam according to their rules and regulations. Every doctor who does consultative exams is independent of the SSA. Instead, this doctor works as a contractor with the SSA to perform these exams in addition to their own personal practice.
One important thing to understand is that the SSA’s policy gives more weight to a consultative doctor’s opinion than that of your personal physician. This means that if your physician says you’re disabled or cannot work but the consultative doctor disagrees, then they’ll likely deny your SSD claim.
Do I Have Any Rights Regarding My Exam?
You do! While you probably can’t choose the consultative doctor that conducts your exam, there are protections in place to prevent this requirement from being a burden on you.
One of those protections is that the SSA pays for your consultative exam. You should owe no out-of-pocket costs or fees to the Social Security doctor you see.
And if you must travel to reach the Social Security doctor, the SSA must reimburse you for those travel-related costs. This can include things like money spent on gas, mileage, or toll road fees.
Finally, if you are homebound and have no transportation, the SSA will send a doctor to perform the exam in your home.
How Should I Prepare for a Visit with a Social Security Doctor?
Going for a consultative visit isn’t unlike going for a normal doctor’s appointment. So, being prepared can help the process go smoothly and lead to a better outcome. At minimum, you should plan to be punctual and answer any questions during your exam. It’s also a good idea to take whatever medical records you already have with you.
Unlike an appointment at your family physician’s office, a consultative exam focuses on issues directly related to your SSD claim. This might mean the exam doesn’t take quite as long as a normal annual physical. That said, it can span several hours if the Social Security doctor must perform certain psychological tests. That’s common if your disability claim focuses only on mental health issues, not physical ones.
It’s also a good idea to take some time before the appointment to think about how your injury or illness affects your everyday life. Questions about what you can and cannot do can impact your SSD application. it’s important that you communicate clearly how your injury or illness prevents you from doing things you could do before in your daily life.
A consultative exam might not feel as warm and fuzzy as a visit with your family physician, but that doesn’t mean that you should come any less prepared. Remember that office staff will likely observe and report their impressions of you to the Social Security doctor. For that reason, it’s important to be polite, clear, and direct when communicating with them.
What Can I Do if I Don’t Like the Social Security Doctor at My Exam?
The SSA gives you the right to contest the assignment of a consultative physician if you feel that the doctor isn’t qualified to evaluate you or your health. It can be hard to prove, but situations like being denied benefits after a previous consultative exam with the same physician may succeed.
Should I Have an Attorney?
Navigating the system and understanding what’s required for a successful disability claim can be confusing and frustrating. Having a Social Security attorney can almost triple your odds of winning benefits.
Think you might have a case? Scheduling a free consultation can help you understand whether you will benefit from legal assistance. Click the button below now to sign up for a free, no-obligation phone call to discuss your claim.
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Lisa Allen is a writer and editor who lives in suburban Kansas City. She holds MFAs in Creative Nonfiction and Poetry, both from the Solstice Low-Residency Program in Creative Writing at Pine Manor College. Prior to becoming a writer, Lisa worked as a paralegal, where she specialized in real estate in and around Chicago.