Ever wonder what Social Security consultative examiners – the doctors who meet with disability applications to decide if they are disabled – think of the Social Security disability process?

Writing in Guernica, Dr. Heather Kovich discusses  her experiences as a (former) Social Security disability examiner:
There is also a stereotype of the doctors who do this work: lazy and disinterested. I found the job fascinating. The more I learned about the disability system, the more I pondered its complexities: it provides a safety net but keeps people mired in poverty. Helpful services, including job retraining, are available, but aren’t advertised. And the system rests on a deeply flawed premise—that there is a way to objectively determine who is able to work and who is not.

…

This was my job, “independent medical examiner.” On the basis of a forty-minute interview and examination, I was supposed to determine how disabled an applicant or “claimant” was. 

…

I did hundreds of disability exams over the next year, and while I did meet two people who were obviously faking, for the most part the stories I heard were heartbreaking: car accidents, massive strokes, lost jobs, dead spouses. Many people who apply for disability have lived through a tragedy. But the stories also told of the inefficiencies of the disability system. That first day in Spokane I met a man who had worked in manual labor his whole life, but for years had been getting crushing chest pain after walking a few blocks. His blood pressure was dangerously high. His condition was obviously treatable, but he did not have insurance so he had not been to a doctor in years. He knew that if he qualified for permanent disability he would eventually get Medicare or Medicaid and get proper treatment. He had no idea he could go to a community health center, a federally financed clinic where he could pay on a sliding-scale basis. With the right treatment and a less strenuous job, he would probably have not needed disability. Emphasis added.
This is the catch 22 of the Social Security system: with the health insurance Social Security provides, you might not be disabled. However, without Social Security disability, you can’t get the medical care you need.

This isn’t strictly a Social Security problem, it is US health system problem.

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Social Security has physicians review disability cases as medical consultant’s to make opinions on individual’s abilities and limitations. However, what good is the medical consultant’s opinion if they don’t have expertise in with the disability in question.

Per Nate Craig:
… you may also want to look at the Medical Consultant’s Code attached to the State Agency’s opinion. I am finding more and more reviewing physician’s making opinions outside their professional field. Recently an ALJ relied on the State Agency’s opinion where the initial decision was made by a SDM and then affirmed by a “dermatologist” MCC of 6. The AC kicked it back with the directive for another physical CE. At the remand hearing, the same ALJ entered a decision of disability back to original onset date.

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How do you begin to review your Social Security exhibit file? Here is a quick guide to finding the really important parts.

Start with the “F” section to review the medical records.

If you do not review anything else in the file, you need to know what medical records are there (and what records are missing).

Here is what I look for:

Are all the doctors and hospitals listed? If the doctor or hospital is not listed, …

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I was recently asked how long after Social Security sends you to a doctor for a consultative examination will it take to get a decision.

I previously wrote about how long it takes to receive an initial decision after you apply for Social Security disability benefits and how long it takes to get a Social Security hearing.

Unfortunately, there are no hard and fast rules for how long it will take to …

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Here are some common questions I hear when Social Security schedules an evaluation or examination with one of their doctors:
Do I have to attend the consultative examination?
Since you are applying for Social Security benefits, you have a duty to assist Social Security in obtaining the information it needs to evaluate your case. This includes going to evaluations or examination that Social Security may schedule for you.

So, “yes,” you do have to go the examination.

Of course, Social Security cannot make you attend a consultative examination. But if you do not attend, your case may be denied, or even dismissed.
What if I cannot attend the consultative examination?
If you cannot attend, contact Social Security right away.

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Has Social Security sent you to a doctor for an examination? Here are some things you should know when going to a consultative examination. 

The examination begins earlier than you think:

You are observed from the moment you enter the office. 
The observation continues in the waiting area and you may even be observed when you walk back to your car. 
The examination may include how you walk from the waiting area to the examination room and your ability to climb on and off of the examination table.

Your behavior may then become part of the doctor’s report to Social Security.

In my experience, the chance of a Social Security consultative examination proving that you are disabled …

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Your doctor’s opinion of your disability is critical evidence in your Social Security disability case. If your doctor does not believe in you, you and your lawyer are facing an uphill battle.

Chances are, Social Security either sent you to one of their doctors for a consultative examination, or had your medical records reviewed by a Social Security doctor. If Social Security denied your claim, their doctors probably did not think you were disabled.

So, here is the problem: if the Social Security doctor says you are not disabled and your doctor does not believe in your disability, you may not have the evidence you need to prove your …

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