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Consultative Examinations During COVID-19

What is a Consultative Examination?

A Consultative Examination is a medical examination required by Social Security (SSA) in many disability cases. This examination is scheduled by SSA if they determine that more information about a Claimant’s medical conditions is necessary in making a determination on a claim. There are two types of Consultative Examinations: mental health and physical health. Some Claimants will only require one type of examination, while others will require both. SSA will reach out to individual Claimants in order to schedule a Consultative Examination. These examinations are performed by doctors, psychologists and other licensed practitioners who are under contract with SSA or its authorized state agency. Claimants do not have to pay for these examinations. It is important to attend and participate in your scheduled Consultative Examination as it factors into determinations at the initial, reconsideration and hearing levels. In the south-central Pennsylvania area, most of these exams take place in an office in Mechanicsburg, Cumberland County. SSA will reimburse you for the reasonable cost of attending the exam.

Does the person doing the Consultative Examination have access to my medical history?

Social Security or its state agency may make a limited number of pages of medical records available to the person doing the exam. These could be hospital reports or records of medical tests. You will also be asked to provide a written medical history. Be sure to be thorough, including information about doctors you have seen, hospitals you have been to, tests you have had, and all forms of treatment including medication. If you have medical records you want the examiner to review, you can bring them to your appointment or send them to the person who made the arrangements at least 10 days ahead of time.

Have Consultative Examinations been affected due to COVID?

Yes. When the order restricting in-person business went into place, Consultative Examinations had to be put on hold. This caused claims to be held up the initial level and at the reconsideration level. Fortunately, SSA has recently determined that mental health Consultative Examinations can resume electronically. Claimants who need mental health Consultative Examinations will be asked if they consent to an examination that will be completed via video telecommunication. This will allow mental health claims to proceed faster. Physical examinations are still on hold.

Do I have to consent to a Consultative Examination performed via video?

No. You do not have to consent to this form of examination if you are not comfortable doing so. At this time, there is no reason to believe that a video mental health consultative examination will be significantly different from an in-person mental health examination; however, if you do not want to move forward with a video examination, your claim will likely be halted until in-person examinations are able to resume. At this time, there is no timetable for when these examinations will resume. Claimants who would like a faster response from SSA might be more inclined to move forward with a video examination.

How do I make the connection for the video examination?

We expect that Social Security will provide written instructions. You will need to have a device (a laptop or a cell phone) with a camera able to take video images. The device does not have to be yours; you could borrow one from a friend, neighbor or family member. Make sure that the device is charged enough to last for at least one hour. If using a phone, make sure you have enough minutes of use for an hour. You should arrange to be in a quiet, private space where you will not be disturbed by others or bothered by noise.


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