The purpose of the Social Security Disability SSI medical exam
A fairly high percentage of individuals who file for either social security disability or SSI disability benefits will be required to go to a medical examination by the social security administration. Unfortunately, many, if not most, disability claimants do not understand the purpose of such an exam, why it has been requested, or who the medical examiner conducting the exam really is.
First of all, let's deal with proper terminology. Social Security Disability medical exams a.k.a. SSI medical examinations are actually called CE exams. CE stands for consultative examination.
Who schedules CE exams and what is the purpose of a CE examination? Consultative examinations are requested by disability examiners (examiners handle initial disability applications) and also by administrative law judges at the disability hearing level. The purpose of such an exam is typically to obtain medical record documentation in situations where:
1. Additional information is needed to properly adjudicate a claim (for instance, for a respiratory allegation, a breathing test may be needed, or a claimant with arthritis may be sent to an xray exam if xray reports are not available in the claimant's own records).
2. Disability claimants simply have not been to a doctor recently (examiners, in particular, need recent medical evidence in order to determine if a claimant's disability exists in the "here and now").
In either case, the scheduling of a "social security medical examination" implies that additional information is required for an adjudicator (a disability examiner or a disability judge) to arrive at a decision. And, typically, the implication is that an approval will not be possible without obtaining additional records (consultative examination reports count as medical record documentation).
Who performs social security medical exams? These examinations are peformed by independent physicians and psychologists who have contracted to examine disability claimants and provide written reports afterward. In other words, despite the assumptions of many, the doctors who perform such exams are not social security doctors. They are not employed by SSA, but, rather, are independent contractors who are paid for services that are rendered. Consultative exams, of course, can be physical in nature, or psychological (IQ testing) or psychiatric in nature.
How long does a consultative exam last? This can depend on the type of exam a claimant is sent to. Examinations for physical allegations can be relatively brief (fifteen minutes is not abnormal), while a mental exam can take considerably longer due to the auditing nature of a psychological or psychiatric examination.
Here are a few other points to keep in mind regarding CEs, or consultative examinations:
1. Social security medical exams are not for the purpose of rendering medical treatment.
2. Disability examinations that are scheduled by a disability examiner or a disability judge are mandatory and failure to attend can result in a decision based on existing evidence---or the closure of a case (for a failure to comply).
3. Physicians and psychologists who perform consultative exams are generally required to submit the results of an examination within ten days of the date of an examination.
4. A CE exam is often the final step in the processing of a disability claim (as regards the gathering of medical records).
In short, being required to go to a medical exam by social security is no cause for alarm. Quite the contrary, it signals that every attempt is being made to make a decision on a claim and that the possibility of an approval exists.
Additional information on Social Security Disability at www.ssdrc.com
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