Exam Secrets

Saturday, November 17th, 2007

The Social Security Administration (the “SSA”) has many regulations and secrets concerning a consultative examination (“CE”). A CE is when a doctor selected by the SSA examines a claimant.

One secret is that even though the SSA has claimants sign authorizations so they can receive copies of CE reports, the SSA never provides them. The SSA also does not tell claimants that it pays the same doctors to examine thousands of claimants, and these CE doctors rarely conclude that claimants cannot work.

Being familiar with CE secrets and regulations can be critical to obtaining benefits. I just succeeded in having a 43 year old client’s disability application approved without a hearing based on such knowledge.

As usual, Disability Determination Services “DDS” represented that the claimant had to attend a CE. I advised the DDS it is not allowed to order a CE simply for a “second opinion”. However, I told the DDS that if it contended a CE was needed to provide additional information, then the regulations required that the CE be performed by the “preferred source,” which is the treating physician. The DDS agreed and the treating physician’s CE report completely supported the client’s inability to work. Nonetheless, the DDS still denied the disability application despite lacking any grounds whatsoever for doing so.
The good news is that the DDS’s conduct was so patently wrong that the SSA approved the client’s disability application less than a month after it was submitted. Had I permitted the claimant to attend a CE by the SSA’s non-preferred source, it is very unlikely that the disability application would have been approved without a hearing.

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