Why does Social Security send claimants to doctor exams?

by Lisa on August 4, 2011

Generally, if a claimant does not have adequate or enough recent medical evidence to prove their claim, Social Security will opt to have a medical examination done. This is called a “consultative examination” in the Social Security world.

Basically, a claimant has the right to have a fair, impartial, intelligent expert to review the medical portion of their claim. A medical physician hired by the Social Security Administration to review a claim should be the person to assess whether or not a consultative examination is necessary.

To maximize the chances of receiving a quality review of a claim, it is recommended that all claimants send a letter to the claims adjudicator assigned to their claim in the beginning of the process, advising as follows:

“I am writing to request that the medical portion of my claim be reviewed by a fair, impartial, competent licensed medical physician, osteopath, psychiatrist or psychologist. I object to a non-medical person evaluating the medical portion of my claim. I request that you maintain this letter in my claim file until my claim has been completely resolved.”

It is also recommended that claimants or their representatives remain actively involved in the claim, keeping in touch with the claims adjudicator often to resolve any problems that may arise, to keep apprised of the status of the claim, to determine what evidence is outstanding and to make sure that the claim is being processed efficiently and properly. By doing this, the claims adjudicator will understand that the claimant is very serious about their claim and that they are willing to assist him or her in any way possible to move your claim along.

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