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Consultative Examiners and Examinations in the DDS Adjudication Process


 

In some disability claims, the evidence provided by a treating doctor or other source is not sufficient to make a disability determination. In these claims, the SSA/DDS will send the claimant for a “Consultative Examination” or a CE in order to obtain the missing information.

Consultative Examinations (CEs) can be provided by your treating doctor if they have the skills to complete it, but more often than not, you will be sent to an independent contracting medical provider who is paid by SSA to conduct the examination.

Doctors who perform these examinations are licensed physicians, osteopaths or certified psychologists, optometrists, podiatrists or speech-language pathologists.

Consultative Examiners will never be chiropractors, naturopaths’, herbalists or other alternative healer type providers, since they are not considered acceptable medical sources by the SSA for the purpose of disability evaluations.

The role of the Consultative Examiner is to provide a standard examination and provide a report to the DDS office which highlights:

n Your chief complaints and a history of same

n A detail of findings based on your history, including examination and laboratory tests as related to your main complaint

n Results of lab and other test performed according to the Listing of Impairments

n A diagnosis and prognosis for your impairments, and

n A statement about what you can do despite your impairments (i.e. functional limitations).

 

Source: Nolo's Guide to Social Security Disability: Getting & Keeping Your Benefits

 

The opinion or statement of your treating physician will carry more weight than that of a Consultative Examiner. This is true to the extent that your treating physician’s statement is deemed as credible based on the objective medical findings documented in your medical record.

 

Summarizing

So you can see that Medical Consultants employed by the DDS office are not the same as Consultative Medical Examiners who examine claimants outside the DDS office.

On the one hand is the MC provider who never sees you, but who does a paper review of your claim to make disability determinations, while on the other hand is the CE provider who does examine you, and then reports his finding to the DDS office.

Though the CE doctor issues an opinion or statement on your medical condition, he has no authority to make the final decision on your disability claim because he has not been trained to do so by the SSA. The CE provider is just a regular medical practitioner in the community who has agreed to perform medical examinations on claimants in keeping with SSA/DDS disability protocols.

Hopefully now when your Claims Examiner tells you that your claim is in the Medical Consultant’s office for review, you will know that you should receive a decision very shortly, usually within 10 to 30 days.

And, if the examiner tells you that you have been set up for a Consultative Examination, you will know that you will be seeing an independent medical doctor or psychologist who is charged with filling in some missing information in your claim record. This information allows the internal Medical Consultant to make a thorough paper review and assessment of your medical disabilities.



Resource Box:

Grid Rules – See the rules SSA / DDS uses to determine if you are disabled or not.

SSA Listings of Impairments – Your claim will either be decided using these rules or the Grid Rules.

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