What happens if you don’t go to your SSDI consultative exam?

When you filed for Social Security Disability (SSDI), you expected a lot of complicated forms would have to be filled out, and you expected to wait a long while for a decision.

You didn’t expect to be sent to a strange doctor for a consultative exam — but that’s what’s happening. The Social Security Administration (SSA) has informed you that they’d like another doctor to take a look at you before they make their decision. Ultimately, however, it’s your choice.

What happens if you decline to go?

Your claim will most likely be denied

If you don’t go to the consultative exam(s), SSA will make a decision on your claim based on the evidence that’s already in your file — and that almost surely will result in a denial.

Why? Simply put: It takes a lot more evidence to approve a claim than it does to deny it.

If you’re being sent to a consultative exam, that’s actually a positive indication for your claim. There’s at least enough medical evidence already in the agency’s records to suggest that you might qualify for disability benefits — but not enough to definitively approve the claim. If there were any less, your claim would simply be denied.

Consultative exams are designed to fulfill several different purposes:

  • They can be used to confirm or refute the findings of your other medical providers. This eliminates any personal biases that may come from your long-standing relationships with your regular doctors.
  • They can fill gaps in your medical records, particularly if you haven’t been evaluated or treated for a condition very recently — including situations where you haven’t been able to afford care. This helps confirm that your condition is still ongoing.
  • They can clear up discrepancies in your record. For example, maybe a specialist you saw in your past felt that your back condition wasn’t enough to cause significant pain, while another says it’s totally debilitating. A consultative can serve as a tie-breaker.

Consultative exams can feel scary, but they are necessary to attend if you want to get your SSDI claim approved. Understanding more about the claims process and your legal options can also help.

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