Medical Consultants vs. Consultative Examiners: An Overview

Medical Consultants (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 abilities.

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 vocational/work history.

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 Examiners/Examinations (CE): A 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.

Next...Medical Consultants in the DDS Office

                                       

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