Many people who apply for Social Security Disability Insurance (SSDI) receive a letter asking them to see a doctor at the program’s expense. This can be confusing for applicants. After all, why does the SSDI send people to see an internist at their expense, even with all the applicant’s medical records?
If Social Security requests that you visit a doctor at their expense, it suggests that the disability examiner believes there is insufficient medical support for the disabilities you claim. Often, this results from you not seeking medical care on your own.
Keep reading below for more information.
Why Does SSDI Send Individuals to Internists?
You could get a letter requesting that you undergo a consultative examination (CE) if you filed for Social Security Disability Insurance benefits. A CE test is intended to assess your limitations and present medical state.
Getting a CE request indicates that the medical data you provided in your SSDI benefits application was insufficient for the disability claims examiner in your state to establish if you have a disability and how severe it is.
The Social Security Administration’s Disability Determination Services (DDS) conducts reviews of disability applications in every state (SSA). The DDS advises the SSA on whether a person qualifies as disabled for Social Security benefits.
If your medical condition is anticipated to last for at least a year or may cause your death, SSDI will pay you monthly payments. You must, however, demonstrate that you cannot work at your most recent position or any other positions for which you might be eligible so that you may be granted these disability benefits.
A claims examiner needs as much data as possible from your medical file since medical documents are crucial to demonstrating your disability.
On the one end, you might be reluctant to get a CE, particularly if you think you told the SSA enough about your condition. On the other end, by refusing the CE request, you can risk losing out on the chance to get disability payments.
For more information on the consultative exam, watch this video below:
What is a Social Security Consultative Examination?
Can Your Doctor Do The Consultation Exam?
Although the SSA employs independent medical professionals or psychologists to carry out CEs, the SSA asserts that it prefers to get medical data from the physician who is caring for the patient with a disability.
This is the reason a disability claims examiner might get in touch with your treating doctor’s office to get the information they need. You may have previously completed a test, evaluation, or examination that the disability claims examiner reviewing your application needs in your situation.
If so, the examiner can receive the documentation from your doctor’s office.
If the SSA believes your doctor is competent, prepared, and ready to examine the cost stipulated by the SSA, they may conduct the CE. There is a benefit to having your doctor perform the exam, particularly when you’ve been going to the doctor for a while, and they know how to treat your disability.
In this kind of scenario, the Social Security Administration will review the notes your doctor makes on your status, as well as the doctor’s assessment of whether your condition is improving and whether and when you are able to return to work.
While having your doctor do the CE may be preferable, there are various reasons why this might not be possible.
- The cost that the SSA pays to conduct the exam might not be acceptable to your doctor.
- Your doctor might not have the medical training that the Social Security Administration requires to do the test. For instance, the SSA would prefer that a psychologist, instead of a general practitioner, examine you to determine your mental disability.
- Your file may contain discrepancies or disagreements that the claims examiner could not resolve based on your doctor’s notes or other medical information.
You might have a justification for preferring that another medical professional do the CE.
Speak to your doctor if you prefer that they lead the CE. Continue with the previously scheduled CE if your doctor won’t permit it. Attend the CE on the specified date, time, and venue. Social Security will cover the cost of the CE and pays for your transportation.
Call to cancel and reschedule if you can’t make the appointment. If you don’t obtain a CE, the examiner for disability claims may determine that you are not disabled and reject your claim.
How to Prepare for a Consultation
The kind of CE necessary will depend on the data a claims examiner requires to answer any unresolved issues regarding your impairment. For example, if an X-ray, blood test, or other laboratory tests will provide the medical details the disability examiner wants, you could skip an examination.
Inform the physician about any new symptoms or physical changes after you submit your disability claim if the doctor inquires about your current health. Describe how this change has affected your everyday activities, for example, if a back ailment has made you less mobile or you may require an assistive device
Mention any hospital stays or operations you’ve had due to problems from your disability. If you haven’t done so previously, share this new information with the person evaluating your disability claim.
The doctor might inquire as to why you think your condition keeps you from working. When responding to the questions, be truthful and precise. Describe how your physical or mental health affects your capacity to perform your current job.
The doctor will send the DDS your test findings or the outcome of your examination following your CE. Even though every medical case is unique, a doctor’s report often contains the following:
- A condition’s diagnosis and prognosis
- Findings from a test, examination, or piece of lab work
- A declaration regarding the patient’s capacity to work, the kinds of work activities they can still perform despite their disability, or the patient’s inability to work.
Remember that the physician performing the CE won’t treat your disability or any consequences it brings, nor will they prescribe you any medications. However, in a report to the DDS, the doctor might make note of your symptoms or other health conditions.
Conclusion
In conclusion, if you’ve received a letter from SSDI asking you to visit an internist of their choosing, it’s important to make an appointment as soon as possible. Transparency is key when applying for programs like SSDI.
