When you submit a disability application to Social Security, an examiner will review your case using a five-step sequential evaluation process. After it has been determined that you meet income guidelines, the examiner will begin reviewing your medical files. Your files are the single most important part of your claim, and will play a large part in determining whether or not you are approved for benefits.
To review your case, it is assigned to a disability examiner. Sometimes they are also known as claims representatives, adjudicators or other similar names. It is up to the claims examiner to begin the process of interpreting your files to see if you meet the standards for disability approval. Disability examiners are the primary case managers at the initial submission level and at the reconsideration level if you are initially denied benefits.
In some cases, your disability claim will be obvious because the condition will be severe enough that you will be approved for disability with little review. This is generally the case if your condition is listed in the Social Security Blue Book of Impairments. However, if your conditions is not listed in the Blue Book, your path to approval is a little more involved.
A disability examiner will often work with a medical examiner who has a more in depth knowledge about medical conditions and will be able to assist in determining just how severe your condition is. The medical examiner will also review your records and based on their findings, will either confirm your condition is serious enough to warrant a disability designation, request that you provide more medical information, or require you to attend an examination appointment.
You should take the request for information or attending a consultative exam seriously, since they will have a primary bearing on whether or not you are approved or denied.
Social Security in most cases always wants to see your most recent medical records, and defines “recent” as within the past 90 days. Anything older than this tends to be discounted and could actually hurt your chances if you do not also provide current information.
If you are asked to go to a consultative exam, it could be for any number of reasons. Social Security may simply want more current information regarding your case, or they may want a single test done to help confirm your disabling condition. They may include an x-ray, blood work, a psychiatric exam or any other number of procedures. It will depend fully on what your case is all about. A consultative exam may also include basic physical testing to see if a claimant is able to perform various types of work tasks that may also help determine disability eligibility as well.
If you are asked to go to a consultative exam, it is critical that you don’t miss the appointment. Doing so will put your claim in serious jeopardy of being denied. At the very least, if you must reschedule it could add a significant delay to your decision.
The important thing to remember when it comes to all contact with Social Security and your medical records is to be as responsive as possible and as quickly as possible so that your claim can be decided in the shortest possible time frame.
