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When applying for disability benefits will I have to see a Social Security doctor?

By   /  March 3, 2016  /  552 Comments

Learn when applying for disability benefits means that Social Security will send you to a doctor for evaluation and find out who will pay for the exam.

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Watch the Video: “When applying for disability benefits will I have to see a Social Security doctor?”

When a Consultative Examination Is Required

Social Security will only send you to a doctor for a Consultative Examination if the medical records and other information you submit when applying for disability are not enough to make a decision on your claim.

Your Responsibility to Prove Your Disability

If you are asked to go for an examination, you will receive a letter from the Disability Determination Services, which is the agency responsible for reviewing your claim. The letter will give you the name and contact information of the examining doctor, the time of the appointment, and how to confirm that you will attend. It is very important to your claim to confirm the appointment by the date given and to attend the examination on time and cooperate fully. If you fail to do so, your claim is likely to be denied.

When a Psychological Examination Is Required

Sometimes people who are applying for benefits based on a physical condition ask, “Why am I being asked to see a psychiatrist? I’ve never been treated for an emotional problem.” Certainly, that situation can be confusing, but Social Security has a reason for asking you to attend a psychiatric evaluation. Here it is: If the information in your claim file doesn’t support the physical disability you claimed and your reported physical symptoms could be caused by a psychiatric illness, then Social Security wants to find out whether you qualify for benefits based on a mental illness. For more information on how Social Security evaluates your disability application, please visit our article “How Does the Social Security Administration Apply Social Security Disability Laws to Determine If I Am Disabled?” and “Who Decides If I Am Disabled? If Both My Doctor and the Social Security Disability Doctors Say I Am Unable to Work, Will I Be Approved?”

The Doctor, the Purpose, and the Cost for the Examination

Just as an aside, the doctor to whom you are sent is not actually an employee of the Social Security Administration. Social Security asks a qualified doctor as close as possible to your home to perform the examination. Your own attending physician may even be asked to perform the consultative examination if he is qualified to do independent exams and is willing. A final note: the appointment has been set because you applying for disability and it is for evaluation only, not for treatment.

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552 Comments

  1. Shelly says:

    I applied for social security disability in June. I’m almost 49 and have worked in clerical type positions for the most part of the past 30 years. I have tendonitis, carpal tunnel, ulnar neuropathy, bursitis in my hip and osteoarthritis in some joints (hand, knees and shoulders at least). I had to go in for an exam with a social security doctor. At the end of my exam he confirmed that I had all but the tendonitis (he didn’t mention it to me). He offered suggestions to me as to what to do to alleviate some of the pain I have. I actually felt kind of positive when leaving the exam. I’ve heard stories of how the ss doctors try to prove that you don’t have any problems. He asked me if I can drive. My response was I can drive but usually my husband does. I should have included that I can’t drive for very long or I start having bad pain in my hands and arms. I am feeling anxious and I have two questions for you:
    Should I let the claims examiner know that I am unable to drive for distances since they specifically asked if I can drive?
    With this brief description of my situation do you think my chances are good to be approved?
    I am anxious and curious. My exam was a couple of weeks ago and am not sure how long it will take to know for sure.

    • Kay Derochie says:

      Dear Shelly,

      If the physician has not yet submitted his report, you could ask to go on record that you gave an incomplete answer about driving, that you do not drive long distances. Give an estimate of how long you can drive at a time and why you are limited from more. If the report has been submitted, it is too late.

      Sincerely,
      Kay

      • Shelly says:

        Thank you for responding to my question. At my CE the doctor confirmed that I have carpal tunnel, ulnar neuropathy, bursitis and arthritis in my shoulders. I actually felt somewhat positive when I left my appointment. Should I expect to get denied and have to go to the appeal process? I know the information I’ve given to you is brief and I understand if you are unable to answer this.

        Thank you,
        Shelly

        • Kay Derochie says:

          Dear Shelly,

          I cannot say whether or not you will be approved, but at this point there’s no reason to assume a denial.

          Sincerely,
          Kay

    • Nita Brown says:

      Hi Kay I had a telephone interview May17.2016 I filed for my son who has a severe learning disability hes in IEP and speech. The school social worker always said he has a low tension span. Hes been in special education since Kidnergarten. For the past two years a very low IQ and does poorly on grade level tests.I work really hard with him. He needs one on one for all classes excepy Science and Social Studied. DDS first contacted me because they couldn’t get his school records in June. I contacted the school in June and they said they had 10 days and will surely send it. I called the DDS worker and she said all of my other documents were fine. July I was sent a psychological evaluation for him in August. I was told I would hear something back in two weeks so I called the 1800 number and all they could tell was that my son’s case is still pending and that I need to call DDS back because DDS is still trying to figure out if his disabled. Do I still have a chance of being approved?

      • Kay Derochie says:

        Dear Nita,

        There is a reasonable possibility your son will be medically approved, but it is important to get the school report in. I recommend calling DDS to find out whether or not it has been received. If it hasn’t, call the school and ask what needs to be done to get the IEP and other requested school records released right away.

        Sincerely,
        Kay

        • Nita Brown says:

          Kay Thanks for reaching back out to me. So I talked to the disability exam worker today about my case she said his psych evaluation came back and she is waiting for the school records that she requested September 7. I will be calling the school or going up there first thing tomorrow.

  2. David says:

    I have been to a psychologist and he stated I am unable to work. I have a lot of phobia’s that limit me from doing a lot of jobs, dizziness, panic attacks, anxiety, learning disability and unable to understand directions, also have imbalance problems due to a hearing impairment and was in special education classes all my life.

    I filed for social security back in 2013, but got denied, saying I wasn’t disabled, but I reapplied again back in June, because I have not been able to keep a job past 3 months that I have done.

    Do you think I would get approved?

    • Kay Derochie says:

      Dear David,

      As you describe your medical and mental illnesses, you may be eligible. If you are denied this time, do appeal with the assistance of an experienced disability attorney. When you hire a Social Security attorney, you do not have to pay any legal fees up front and you will pay attorney fees only if you are approved for benefits. Social Security law sets the amount your attorney can charge, and the Social Security Administration pays the attorney directly from your retroactive award before they send your back pay to you.

      Sincerely,
      Kay

      • Susan V says:

        Dear Kay,
        I was injury at work 2011 undergoing treatment with with work comp Doctors. I had lumbar decompression done 2014, both hands carpal tunnel surgery done recently ( R done last 3 mins, left only 2 weeks), pending for neck fusion surgery due to CST . Failed back surgery caused me stool/ urine incontenenc that makes my doc urged insurance to send to the spine surgeon. My conditions now is daily headaches , neck aims wrists , hands , back pain , can not sit stand walk longer 15 minutes. I also depressed anxiety treatment I just have hearing with all Wcomp medical evidence up dated with monthly treatment and daily medications After the hearing , the judge said he needed to send me to take several X-ray for neck shoulders, hands , back and Psych evaluation. Then back here within 6 weeks. I am confused. I was denied at initial in 2014 after they sent me to their psych Doctor. ( I am a desk job computer work) I am so depressed please advise me why and what the judge ask for it. Thanks

        • Kay Derochie says:

          Dear Susan,

          It is possible that the judge wanted some medical documentation that was more current than what was in file when the appeal came to him.

          Sincerely,
          Kay

    • Gilbert says:

      Hi I was recently denied I have bipolar depression and severe sleep apnea. The worker received my medical records and advised me if she needed to send me to a CE doctor she will call. Well she did not call but I received a denial letter.I haven’t worked since 2012 due to the depression, and different medications im on that have several different side effects.My psychiatrist agree that I should not work. Can you be denied without seeing their doctor first?

      • Kay Derochie says:

        Dear Gilbert,

        Yes, a claim can be denied if the medical information in file is sufficient to indicate the person’s illness is not disabling.

        I suggest that you request a copy of your claim file from the Social Security Administration (SSA) so you and the attorney can see the exact reason for the denial and see the evidence it is based on. If you decide to appeal, it could be helpful to hire an experienced Social Security attorney to assist you. When you hire a Social Security attorney, you do not have to pay any legal fees up front and you will pay attorney fees only if you are approved for benefits. Social Security law sets the amount your attorney can charge, and the Social Security Administration pays the attorney directly from your retroactive award before they send your back pay to you.

        Sincerely,
        Kay

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