Social Security Doctors

Monday, November 22nd, 2010

When filing for Social Security Disability (“SSD”) benefits, the Social Security Administration (“SSA”) usually asks claimants to be examined by one of its doctors in what is referred to as a consultative examination (“CE”). The SSA leads claimants to believe that their SSD application will be denied if they refuse to attend the CE.

The SSA rules and regulations actually provide for relatively few situations where a CE would be appropriate. In general, if a CE is actually needed, then it is supposed to be performed by a treating doctor. Nonetheless, in almost every case, claimants are sent letters telling them that they must go to a CE by an unnamed doctor.

I represent a 59 year old teacher who was told that she must attend a CE by Industrial Medicine Associates (“IMA”). After I sent a detailed letter explaining why the rules and regulations showed that such a request was inappropriate, the CE demand was withdrawn, and she received a check for SSD benefits today.

The state agency, which requests the CEs, and IMA, have both told me that CEs are routinely scheduled on every case. I represent a former nurse whose SSD benefits were also approved today, and she was never sent a notice to attend a CE. Therefore, it cannot be said that SSA policy requires a CE in every case.

While there are some circumstances when a CE is needed, since the CE reports normally indicate that the claimant is not disabled, a CE by a non-treating doctor should be attended only if the request is authorized under the SSA rules and regulations.

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