When processing a claim, the Social Security Administration could find the claimant’s medical sources insufficient to support their disability. The agency could request additional medical evidence from their treating physician or an independent health care provider in these situations. If they proceed with the latter option, this assessment is a consultative examination (CE).
Ideally, the claimant’s treating physician is the primary source of medical information regarding the claim. However, some circumstances could make them unable to do so. The SSA could order a CE for specific situations, including the following:
- The claimant’s treating physician refuses to perform further examination.
- The existing medical evidence has inconsistencies, requiring another health care provider’s opinion for reconciliation.
- The claimant wishes to choose a different medical practitioner with good reason.
- The claimant’s treating physician has a history of being a potentially unproductive source.
Choosing a practitioner for the CE could depend on the type of examination necessary to collect adequate evidence for the claim. Nevertheless, the agency must provide permission before proceeding with the CE. The independent health care provider must request approval before performing any examination or tests related to the claim.
Additionally, CEs could lead to additional costs that could vary significantly. Considering all these factors, the agency manages the selection of qualified medical practitioners for CEs. Aside from having the proper licenses, they should have the right equipment and facilities to conduct the required assessments.
CEs can impact a claim’s outcome
Typically, the agency will receive a comprehensive report after the CE. This document could contain vital information that serves as evidence for the claim, factoring in consistency with the claimant’s medical history. Ideally, this CE report could help the agency determine what disability benefits are appropriate for the claimant.