In Oregon, 22% of disability claims have at least one consultative evaluation. Source: SSA State Agency Operations Report, page 149. A consultative evaluation is a medical appointment in which a doctor contracted by Disability Determination Services performs a specific evaluation of one or more of your conditions.
Social Security states that they order Consultative Evaluations only when a claimant does not provide adequate evidence about his/her impairment(s) for the government to determine if they are blind or disabled.
If you have been asked by the government to attend a Consultative Evaluation, we would like to share our advice on how to navigate the process.
Reach out to your treating provider
If you have a treating provider who is willing to answer specific questions about your health issues, you can request that Disability Determination Services reach out to your provider perform the evaluation rather than sending you to a doctor you do not know. It is important to note that, on average, Disability Determination Services spends only $355 per evaluation, which many providers will find does not adequately compensate them for the time they spend preparing the evaluation. Other doctors may decline to do the evaluation because they do not have the specialized training that allows them to answer the specific questions that Disability Determination Services needs to have answered in the report.
Participate in the process
If you do not have a treating provider who is willing to perform the evaluation, it is important to participate in the Consultative Evaluation process fully. This includes: confirming you will attend the appointment, arriving for the appointment as scheduled and putting forth full effort on every component of the testing.
Be careful with what you do and say at the evaluation
It is important to note that the providers hired to perform these consultative evaluations are watching you carefully for inconsistencies from the moment you arrive until you leave. We have seen reports from some providers noting they watched the claimant walk to their car after the evaluation and perceived inconsistencies with how they behaved during the evaluation and how they ambulated in the parking lot.
Be aware that all the information you are providing could be used against you. For this reason, be very careful and accurate on how you report your limitations and what you still can do.
Do not over-state or understate your limitations. For example if you are asked report what you do each day, please be careful to accurately report your daily activities without including things that you used to do and can no longer accomplish. We encourage people to, as appropriate, use qualifiers like “as I am able” or “on my better days.” Even if you are there for a mental exam, know they are observing you for physical impairments and limitations and visa versa.
Most testing has built-in reliability measures to attempt to determine if a person is faking or exaggerating a limitation. For this reason, it is important to put forth your best effort on every component of testing without causing yourself further health issues.
Practice the important questions
If you are dealing with brain injury or some other cognitive impairment, we suggest you practice answering the following questions with a family member before you attend your evaluation:
- Why are claiming disability?
- What do you do each day?
- What are your hobbies?
- What parts of your body hurt?
- What medications and treatments have you tried?
- How are you limited due to mental health conditions?