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New Jersey disability lawyers answer questions about consultative examinations

Many New Jersey disability applicants are asked to undergo consultative medical and psychological examinations. Here from the New Jersey disability lawyers at Zager & Fuchs are answers to some of the questions that applicants for New Jersey disability benefits most often ask about consultative examinations.

What is a consultative examination?

A consultative examination is a physical or mental examination that the Social Security Administration arranges for claimants when it needs to gather more medical evidence to make a disability determination. At the pre-hearing level, it will be arranged by the disability examiner who is handling your claim at the state disability determination services. At the hearing level, the administrative law judge who is assigned to your case may determine that an exam is necessary. He or she will then have the state agency arrange it.

Why does the Social Security Administration need me to have a consultative examination?

The Social Security Administration needs medical evidence to determine whether you are disabled. After you apply for New Jersey disability benefits, the Social Security Administration will contact your treating doctors and hospitals and request copies of your medical records and it will ask your doctors to complete questionnaires to gather the necessary information. Sometimes, the Social Security Administration is unable to gather enough information because, for example:

  • You have not been treated by a doctor at all or for the condition that is causing your impairment.
  • You have a doctor, but you have not told him or her about all your symptoms and limitations.
  • Your doctor has failed or refused to send your medical records to the Social Security Administration.
  • Your medical records from your treating doctor are too old, illegible, or don’t contain the information or specific test results that the Social Security Administration needs to determine whether you are disabled.
  • Your medical records contain conflicting information.
  • Your doctor is not a specialist in the area in which you are having problems and the Social Security Administration needs an expert opinion.

In these cases, the Social Security Administration will arrange for you to have a consultative examination so it can obtain the needed medical evidence.

Who will perform my New Jersey consultative examination?

The Social Security Administration contracts with independent doctors and psychologists in private practice to conduct consultative examinations and provide reports. The Social Security Administration will arrange for you to be examined by a practitioner with the appropriate skills and credentials. Generally, the Social Security Administration will try to arrange for you to be examined at a convenient location near where you live. But some claimants may have to travel a good distance to reach a specialist with the appropriate credentials to evaluate them.

Can my own doctor perform my examination?

Your own doctor may be able to perform your consultative examination if he or she has the appropriate skills and credentials and agrees to do it. For example, if you have congestive heart failure and your doctor is a cardiologist, the Social Security Administration may permit your doctor to perform your exam. In fact, Social Security regulations say that a consultative examination by your treating doctor is preferred.

What should I do if I want my doctor to perform my exam?

If you want your own doctor to perform your consultative examination, you will need to get the approval of the Social Security Administration (i.e., the disability examiner who is handling your claim or administrative law judge). Your doctor will also need to agree. Your New Jersey disability lawyer can help with these arrangements if you are represented. You should know that treating doctors are often reluctant to perform consultative examinations on their patients. Sometimes they are unwilling to accept the relatively small fee that the Social Security Administration will pay. More often, a treating doctor will decline out of concern for preserving the doctor-patient relationship. The doctor will be concerned that the claimant will blame him or her if the claimant is not awarded New Jersey disability benefits.

How much will my exam cost me?

You will not be charged for the exam. The Social Security Administration pays for all consultative exams and reports. This is true even if your own doctor performs your exam. In some situations (e.g., where you have to travel a considerable distance), the Social Security Administration will even pay your travel expenses.

What will happen at my examination?

It depends on what type of impairment you have and what information the Social Security Administration needs to decide your claim. You may need to undergo a complete examination consisting of a medical history, physical, and all of the various laboratory and other tests that are usually administered to diagnose the existence and severity of your impairment. If you have a mental impairment, you may need to undergo an examination and a battery of tests administered by a psychiatrist or psychologist.

But not all consultative examinations are complete examinations. Sometimes the Social Security Administration needs only the results from certain tests to complete your medical records. For example, you may need only a stress test, or breathing tests, or blood tests, or x-rays.

What will happen if I do not attend my exam?

If you have good cause for failing to attend your examination, your exam should be rescheduled. If you fail to attend your consultative examination without good cause, the Social Security Administration will make a decision based on the evidence in your file. If the medical evidence is inadequate, your claim may be denied.

What should I do if I am unhappy with the way my exam was conducted?

Sometimes claimants complain that the doctor spent only a very brief time with them and did not examine them or listen to their complaints. If you are dissatisfied with your consultative examination, you should notify the Social Security Administration. Complain to your disability examiner or your administrative law judge. You should also write a letter that can be added to your file. Your New Jersey disability lawyer can assist you if you are represented.

It is a good idea to bring a friend or family member with you to your exam to be a witness. Your witness can go into the exam room with you and note the time the exam began and ended and what the doctor did.

What happens if the results of my consultative examination are not favorable?

Here is where a skilled New Jersey disability lawyer can help. If the Social Security consultative doctor disagrees with your treating doctor, your New Jersey disability lawyer can ask your treating doctor to address the medical issues raised by the consulting doctor. If your treating doctor can provide a plausible explanation for the different conclusion, the Social Security Administration ought to accept your treating doctor’s opinion.

If the consulting doctor’s report is unclear, your New Jersey disability lawyer may be able to talk to the consulting doctor and get him or her to clear up the problems. Your lawyer can then prepare questions, called interrogatories, that the administrative law judge can send to the doctor to obtain written clarification of ambiguities in the doctor’s report.

Your New Jersey disability lawyer can even have the doctor subpoenaed so he or she will appear at your hearing, where your lawyer will be able to cross-examine him or her.

New Jersey disability lawyers offer help with consultative examinations and all aspects of your disability claim

If you are not already represented by a New Jersey disability lawyer and want our evaluation of your case, give us a brief description of your claim using the form to the right. Or you may contact us at:

Zager Fuchs, PC
New Jersey disability lawyers

Phone: 732-747-3700
Fax: 732-747-2533

P.O. Box 489
268 Broad Street
Red Bank, New Jersey 07701