Medical Consultants vs.
Consultative Examiners: An Overview
(MC) – which
include medical doctors, physicians, specialists or psychologists-- serve as direct staff to or as contractors with
the state DDS. They are usually housed in the DDS offices. A Medical Consultant will either handle claims of all examiners assigned to a particular unit, or
they will review claims agency-wide, based on their medical specialty.
Their duty is to use their professional
medical expertise in determining the extent of a claimant’s functional ability in light of his or her medical
condition(s). These doctors and psychologists never see you in person so they must rely solely on your medical
records (MER) in file to assess your limitations.
After a review of the summary provided by
the claims examiner and your medical records, the medical consultant (MC) will either concur with the disability
examiner or revise the summary findings based on their judgment. In some cases, they will send the case back to the
examiner and request they collect further medical information or they may require the results of certain medical
tests or psychological assessments be performed before they issue a final assessment of your functional
When the medical consultants have completed
their review of your file, the case is then forwarded back to the disability examiner who then assesses your
Based on the level of your restrictions as
determined by the physician or psychologist, the disability examiner looks at your past work history to determine
whether you can or cannot return to your past work. If your medical restrictions indicate that you can not, based
on the specific requirements of that type work, the examiner then has to determine if you can do any other type of
work, based on your age, educational level and physical and/or psychological limitations.
If it is determined that you cannot do your
past job or other work, your disability claim will be “allowed”. If you can do your past work or can do other work,
or it is determined that your disability is not severe or not expected to last at least a year, or that your severe
condition will resolve itself in less than a year, then your claim will be “denied.”
Consultative Examination is a medical exam set up by the disability Claims Examiner for an applicant whose medical
records do not contain all of the pertinent information and/or testing that is necessary to determine whether or
not he or she is disabled. Consultative Examiners are medical doctors, including physicians, specialists and
psychologists, who contract with SSA (DDS) to provide medical examinations of claimants. After they have examined a
claimant (in person), they issue a report on their medical findings to the DDS office.
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