Understanding the Role of Medical Examinations in SSDI Claims
When evaluating a Social Security Disability Insurance (SSDI) claim, the Social Security Administration (SSA) relies heavily on medical evidence. However, in many cases, the medical record is incomplete, outdated, or lacks sufficient detail. This is where consultative examinations (CEs) and medical reviews play a critical role.
If you are soliciting benefits or are a referring attorney, understanding these processes can help you better assess the strength of a potential claim.
What Is a Consultative Examination?
A consultative examination is a medical evaluation requested by the SSA when:
The claimant’s medical records are insufficient.
There are inconsistencies in the diagnosis or treatment.
The severity of the condition needs clarification.
These exams are conducted by doctors hired by SSA, not the claimant’s treating physician. The goal is not treatment but rather to evaluate functional limitations and confirm diagnoses that impact the claimant’s ability to work.
Key Points You Should Know:
CEs are not optional — if a claimant misses the appointment, the claim can be denied for failure to cooperate.
The examiner may not have full access to the client’s medical history, which makes pre-exam preparation critical.
The resulting report will weigh heavily in the SSA’s decision-making process—sometimes more than the client’s own doctor’s notes.
What Is a Medical Review?
A medical review is an internal process within SSA where a medical consultant (often a physician or psychologist) reviews the claimant’s medical file to make a recommendation regarding disability.
This review determines whether the medical evidence meets SSA’s Listing of Impairments, or whether the claimant has a Residual Functional Capacity (RFC) that prevents them from engaging in substantial gainful activity.
Why Walker Firm PC, DBA Casa de la Justicia, can make All the Difference
By working with a SSDI-focused firm like Walker Firm PC, DBA Casa de la Justicia, that represents Spanish-speaking clients, you’re ensuring access to:
Pre-exam coaching so claimants don’t unintentionally downplay their limitations.
A legal team ready to challenge flawed CE reports.
Strategic guidance to strengthen medical records before SSA review.
If you’re working with clients struggling to maintain employment due to chronic illness or a Disability, at Walker Firm PC, DBA Casa de la Justicia, we’re here to help assess their eligibility and represent them throughout the SSDI process. Just call us at 1 800 454 5454 and we will help without a penny coming out of your client’s pocket.
