Tuesday, May 20, 2008

How will a Social Security Doctor determine my illness better than my own doctors?

Someone made this statement recently in a forum. "I don't see how the social security doctor will determine my illness better than the psychiatrist I've gone to for two years.

Guess what? This individual is completely right. In fact, claimants are generally sent to a social security doctor (in actuality, these are private practice physicians, psychiatrists, and psychologists who are paid to perform consultative exams (CE) for social security; in other words, they don't work for social security) for three reasons.

1. To obtain recent medical record documentation if you haven't been seen for your condition in some time (usually more than 60 days). This can take the form of a physical CE or a mental CE that can either be a mental status exam, an IQ test, a memory scale, or a full psychiatric exam.

2. To obtain special testing. You could be sent out for xrays if you've had a bone break, or to spirometry (breathing test) if you have respiratory problems, or to audiometry if you have hearing loss, etc, etc.

3. You could be sent to mental testing even if you did not allege a mental condition on your disability application but there was some indication of this in your file (believe it or not, even if your family doctor who treats you for back problems writes the word "depression" one time in your file).

None of these purposes, however, has anything to do with rendering a final disability determination on your case. The consultative examiner simply examines you, or performs his or her testing, and later submits a CE report to the disability examiner (disability examiners are the individuals who make decisions on disability applications and reconsideration appeals while disability hearing decisons are made by federal judges).

How much weight does the CE report carry? My own estimation is "not a lot". As a disability examiner, I saw a very small percentage of claims that were approved on the basis of CE exam reports.

What then, you may ask, is the purpose of even going to such an exam? Truthfully, most of these exams are scheduled for just one reason. So the disability examiner can say "Yes, I have recent medical documentation" and then close the case.

So, the lesson to be learned here if there is one, is this: when you file for disability, don't assume that if you haven't been going to a doctor that you can be approved simply by going to a social security medical exam. It could happen. But its more likely that, without a record of receiving treatment from your own doctors, your chances of winning disability benefits will be slim.

Return to the Social Security Disability SSI Benefits Blog

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How Does Social Security Decide Your Disability Claim ?


Blogger fedup said...

What do you do when the alj says your doctor does not hold any weight. he is not a expert my doctor has a ten page report in detail about my back problems he also says the mri speaks for it self. the alj says are docs are better and im takeing there advice i have not ever seen a ssa docter.

8:35 AM  
Blogger Disability Blogger said...

I'm only guessing but I would assume that when the ALJ said "our docs are better" he was referring to the medical consultant who signed off on a disability examiner's decision when your case was decided at the initial claim or reconsideration appeal level. What do you do about this? If the ALJ decides to view the available evidence in a particular light, there is nothing you can do about that. If the case is denied, you will need to consider whether or not to appeal to the next level or start over with a new claim.

9:24 PM  

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