What happens at a disability exam? (2022)

by Tim Moore. Free Case Evaluation for North Carolina Residents here.

Social Security Consultative Exams

The Social Security Disability Exam is actually called a CE, or consultative exam. If you are scheduled for a CE, it will fall into one of three types: physical, mental, or testing.

(Read if you live in North Carolina)

Physical Exams

(Video) What is a "Consultative Exam" for my Social Security Disability Case?

A physical consultative exam is not unlike a physical. The doctor will check your vitals, your reflexes, your strength, and if you have a neurological or spinal issue may check your gait or walking pattern. A physical CE is typically short, under 15 minutes. The doctor may ask you questions based on a sampling of the medical evidence sent to them by the disability examiner who scheduled the exam. A physical CE is usually scheduled for one purpose, which is to get recent medical evidence into the file so a decision can be made on the claim. This happens if you have not been to a doctor in at least 90 days.

Mental Exams

Mental disabiltity exams can be mental status exams, full psychiatric exams, IQ testing, or memory testing. Obviously, these types of exams will involve more discussion and interaction between you and the doctor. On a mental exam, you may be asked to count in series of numbers, or be asked very simple questions such as the date, where you are, or who you are, or who the current President is. Mental consultative exams have the potential to have a stronger impact on your disability case, especially if you have both physical and mental impairments because a mental exam can add that last bit of evidence that is necessary to win the case.

Testing

Testing can include the various types of mental testing that we just mentioned. But it can also include an echocardiogram for your heart, or a breathing test if you respiratory problems (spirometry a.k.a. pulmonary function test). It can also include a CBC (complete blood count) or a neurological examination, or visual testing, or audiometry if you have hearing loss.

Why does Social Security send people to disability exams?

Before an examiner can close a case, he or she must have recent medical information regarding your disability (meaning they must have some medical evidence in the file that is no older than the last 90 days).

(Video) What Do Social Security Doctors Look For? | Learning With Liebenhaut

For this reason, if you apply for disability and the disability examiner investigating your case finds that you have not been seen by a medical professional within the last few months, or you have a condition listed on your application for disability but have not actually received treatment for it–such as depression–you will most likely be scheduled to go to an examination appointment.

Going to this appointment is not optional and if you refuse to go, or consistently miss scheduled appointments, your case can be denied. Social Security will, however, reschedule you if you miss one or more appointments but have a valid reason, such as a medical emergency, transportation issues, or even getting lost on the way to the appointment.

Social Security Medical exams–which may be simple physical exams, neurological exams, appointments to have xrays done, mental status exams, memory or IQ testing, and even full psychiatric evaluations–are paid for and scheduled by the Social Security Administration.

The actual process is that a disability examiner will a) determine that an exam needs to be done and b) then ask the PRO, or professional relations office section of the DDS, or disability determination services agency, to make the appointment.

The doctors who perform consultative exams

But..these exams are not conducted by doctors who actually work for the Social Security Administration. They are physicians who are contracted to independently perform examinations and submit a report of findings.

What types of doctors agree to do examinations? Nearly all types. Social Security only requires that the doctor be a licensed physician. That said, many of the physicians who perform CEs do not have positive feelings for individuals filing for disability.

(Video) Seven tips for a Social Security disability medical exam

This, not too surprisingly, is revealed through the myriad complaints that claimants have about the exams they are sent to, such as “the exam was incredibly short”, or “the doctor was rude”, or “the doctor was condescending”.

These are age-old complaints about consultative physicians. And, unfortunately, a claimant can disadvantage their case if they attempt to appear more physically able than they really are, or, when asked by the doctor about their condition, verbally play down the severity of their condition (in one sense, it is amazing that people do this, but the truth is most individuals do not want to apply for disability and, under other ideal circumstances, would prefer to be working).

Be careful when you go to a Consultative Disability Exam

Doctors who have a bias against Social Security’s disability programs, or disability claimants themselves, will sometimes even go so far as to look for signs that the claimant is malingering, such as observing the claimant walking out of the office back to their car (and then write this observation in their CE report that is submitted to Social Security).

Other valid complaints about CE doctors include the fact that claimants with conditions like degenerative disc disease are sometimes sent to doctors whose specialty is completely removed from such conditions, such as gynecologists (this does happen). Also, very often the claimant will find that the examining doctor was not sent any background information by the DDS examiner to give them insight into the claimant’s medical condition.

The reality of Social Security medical exams

Most disability consultative exams are scheduled, not to determine the state of the claimant’s health or even functional limitations, but as a mere formality that must be satisfied before the examiner can close the case.

(Video) What Happens If I Miss a Disability Exam? | Cleveland, Ohio Long Term Disability Lawyer

So, if you haven’t seen a doctor recently, or if you haven’t ever been treated for one or more of your medical conditions, your disability examiner will most likely schedule a physical or psychological consultative exam (or both if applicable).

The effect of a Social Security Medical Exam on your case

A physical CE exam typically offers very little to your case, and will rarely be used to support a claimant being approved for disability. Of course, it’s only logical that a CE can’t be given the same weight as your entire medical history; it can only show your physical capabilities or strength at the time of the exam, and offers no real insight into your medical condition. The brief nature of the exam and the fact that the examining doctor has never met nor treated you illustrates how unlikely it is for most consultative exams to assist a person’s case (nonetheless, if you are scheduled, you must go or risk being denied for failure to cooperate).

As a disability examiner, I found it exceedingly rare for a standard physical CE to have any impact on a claim, other than the fact that it provided recent medical documentation which allowed a disability decision to be made and the case to be closed.

So, is a consultative exam really nothing more than procedural formality, possibly even a sham? Well, the answer to that is, surprisingly, not necessarily.

A physical consultative exam, or CE, can, in some instances provide a disability examiner with an up-to-date snapshot of the claimant’s current medical condition that simply allows the examiner to go ahead with an approval–when the remaining older evidence in the file is strong and validates the case.

Mental Disability Exams

(Video) Beware of Consultative Evaluations Required by Social Security Disability

In addition, a mental CE, meaning a psychological or psychiatric evaluation, can be critical to those seeking disability benefits on the basis of a mental impairment. Many individuals who are filing on the basis of one or more mental conditions have not received regular (if any) mental health care in the past, and the CE could be the only medical documentation or support available to the examiner working on their disability application or request for reconsideration.

The most important thing to remember about a consultative exam is that it is a tool used to further the purposes of the Social Security Disability agency (i.e., closing cases, denying claims) rather than those of the claimant (receiving benefits).

The best thing to do is show up (as stated, failure to participate in the CE could be grounds for dismissal of your claim), and don’t worry about the results-—in most cases, they will not carry nearly as much weight as your past medical history and the observations made by your regular treating physician or medical specialist.

FAQs

How do you pass the Work Capability Assessment? ›

To pass the WCA, your physical and/or mental health condition needs to affect you 50% of the time. You will be assessed on whether you can carry out certain activities within a reasonable amount of time.

What happens if you pass Work Capability Assessment? ›

The letter will confirm what group you have been placed in if you have passed the assessment. If you have been placed in the Limited Capability for Work Related Activity (LCWRA) group, you will usually get extra money on your Universal Credit claim. You may also receive some back payment.

How long does a Work Capability Assessment decision take? ›

It may take four to six weeks after the assessment for you to receive the decision. determines whether you have 'limited capability for work related activity'.

How many points do I need to pass the capability for work assessment? ›

To be assessed as having a limited capability for work, you need to score 15 points or more. Add together the highest score from each activity that applies to you. The assessment takes into account your abilities when using any aid or appliance you would normally or could reasonably be expected to use.

What is classed as limited capability for work? ›

1. Mobilising unaided by another person with or without a walking stick, manual wheelchair or other aid if such aid is normally, or could reasonably be worn or used.

Will my limited capability for work get backdated? ›

In most cases, the LCWRA element is awarded after a 3 month waiting period beginning on the day you provide medical evidence. If it takes longer than 3 months to carry out your Work Capability Assessment the element you are awarded will be backdated to this point and you will be paid any amount owing.

Do DWP go with assessors report? ›

We pass your case back to DWP - When we're satisfied with your assessment report, we send it on to DWP. DWP select reports for quality checking - To make absolutely sure everything is consistent and accurate, DWP also randomly select assessment reports to quality check.

How long do DWP decision makers take 2022? ›

On average, it takes the DWP 20 weeks from the date you started your claim to make a decision.

What does limited capability for work mean on Universal Credit? ›

has limited capability for work – this means the claimant will not have to look for work, but will need to take steps to prepare for work. has limited capability for work and work-related activity – this means the claimant will not be asked to look for or prepare for work.

Why would PIP call me after assessment? ›

The purpose of the phone call is to ensure the claimant understands the reason why PIP has not been awarded or has been awarded at a lower rate and to answer any questions or concerns that the claimant may have about the decision.

Can you get limited capability for work and still work? ›

If you are receiving ESA, the DWP have accepted that you have limited capability for work or limited capability for work-related activity. There are some circumstances where you can work and your entitlement to ESA will not be affected. This is called permitted work.

Can you get limited capability for work and PIP? ›

PIP is unrelated to LCWRA so you can definitely go ahead and apply (if you meet the eligibility criteria), however you would still need to have a PIP assessment.

Can you get Lcwra for depression? ›

Once the DWP are aware of how your mental health condition is affecting your ability to work or look for work, you may receive LCW or LCWRA automatically.

What conditions automatically qualify you for Lcwra? ›

Limited Capability for Work-Related Activity (LCWRA) group
  • You are terminally ill, i.e. you are suffering from a progressive disease and your death in consequence of that disease can reasonably be expected within 6 months.
  • You are receiving treatment for cancer by way of chemotherapy or radiotherapy. ...
  • You are pregnant.

How many points do you need to score to get Lcwra? ›

In order to be put in the LCWRA group you must get 15 points on any one indicator (except in activities 8, 9b, 10 and 15 - 'Finding your way and being safe', 'Consciousness during waking moments', and 'Getting about'). Or meet any of the descriptors in Activity 18 or 19.

What medical conditions qualify for disability UK? ›

What counts as disability
  • cancer, including skin growths that need removing before they become cancerous.
  • a visual impairment - this means you're certified as blind, severely sight impaired, sight impaired or partially sighted.
  • multiple sclerosis.
  • an HIV infection - even if you don't have any symptoms.

How long is LCW awarded for? ›

The DWP will usually reassess your LCW or LCWRA every 1, 2 or 3 years. They might also reassess you if you start work. If you've got LCWRA, the DWP might decide they won't need to reassess you in future - they'll tell you in the decision letter they send you after your assessment.

How many points do you need to be in support group ESA? ›

If you score 15 points or more, you have limited capability for work and your ESA will continue. If the DWP decide that you have limited capability for work, you will be placed in one of two groups: Work-related activity group. Support group.

Do you get extra money on Universal Credit if you get PIP? ›

How does Universal Credit affect PIP and DLA? If you're getting Personal Independence Payment (PIP) or Disability Living Allowance (DLA), it will continue to be paid along with your Universal Credit payment.

How long does limited capability for work get backdated? ›

You can check how much ESA you'll get. The DWP will usually pay up to 3 months ESA to cover time when you had limited capability for work before you applied. This is called 'backdating'. You won't usually get ESA to cover the first 7 days you had limited capability for work.

What medical conditions qualify for Attendance Allowance? ›

Eligibility
  • you have a physical disability (including sensory disability, for example blindness), a mental disability (including learning difficulties), or both.
  • your disability is severe enough for you to need help caring for yourself or someone to supervise you, for your own or someone else's safety.

Do PIP assessors make a decision? ›

PIP resources

A Department for Work and Pensions (DWP) decision maker will determine if you get Personal Independence Payment (PIP) and at what rate. We explain how they assess and score your PIP claim.

Does PIP contact your doctor? ›

The DWP will usually contact your GP or healthcare professional to obtain medical evidence when you submit a PIP or ESA claim, the information is then sent to the DWP as part of your claim process.

What are the 8 points for PIP? ›

Can dress and undress unaided.
  • 0 points. Needs to use an aid or appliance to be able to dress or undress.
  • 2 points. Needs either - ...
  • 2 points. Needs assistance to be able to dress or undress their lower body.
  • 2 points. Needs assistance to be able to dress or undress their upper body.
  • 4 points. ...
  • 8 points.

How long does it take to get a decision after PIP 2022? ›

The whole process from making a new claim for PIP, from the initial phonecall to the DWP through to receiving the Award Letter can take up to 24 weeks, which is around six months.

What are the 12 points for PIP? ›

You get the enhanced rate of daily living component if you score 12 points or more. If you score between eight and 11 points for your mobility needs, you get the standard rate of the mobility component. If you score 12 points or more, you get the enhanced rate of mobility component.

Do you get PIP payment before decision letter? ›

Your Personal Independence Payment (PIP) will start being paid after you receive your decision letter. Your decision letter tells you whether you qualify for PIP and how much you will get. Your PIP will be backdated to when you first made a PIP claim, so you are likely to get a lump sum back payment.

What happens after a DWP health assessment? ›

After your assessment our Healthcare Professional completes a report using criteria laid out by the Department for Work and Pensions (DWP). This is to provide the DWP Decision Maker with an impartial, justified medical opinion about how you are affected by your medical condition.

How many points do you need for limited capability for work and work related activity? ›

A total of 15 points across the assessment means you have limited capability for work. For more information on criteria for both the LCW and LCWRA see the Work Capability Assessment help page.

Does PIP automatically qualify you for Lcwra? ›

If you are pension age and in receipt of Disability Living Allowance (DLA) at highest rate care, Personal Independence Payment (PIP) at enhanced daily living or any rate of Attendance Allowance (AA), you will be awarded LCWRA without the need for work capability assessment.

How do I pass a PIP phone assessment? ›

Things to remember during the assessment
  1. Don't let the assessor rush you and try not to just answer 'yes' or 'no' to their questions.
  2. Always try to explain how doing something would make you feel afterwards and the impact it can have on you if you had to do it repeatedly in a short period of time.
12 Apr 2022

How do I pass a PIP assessment? ›

Prepare for your PIP assessment
  1. Read your PIP form thoroughly. Make any notes of changes to your condition. Remind yourself of your answers. ...
  2. Read the PIP descriptors for each question.
  3. Understand what the PIP assessment is.
  4. Make a list of points you would like to make during your assessment – and take this with you.
18 Jun 2020

How many months can PIP be backdated? ›

How to claim PIP. Claiming Personal Independence Payment can take up to four months after making your claim to you receive any money. PIP cannot be backdated but your payments start from the date you made your claim to cover the handling time at the Department of Work and Pensions (DWP).

Why do I need a work capability assessment? ›

The 'work capability assessment' (WCA) is very important for universal credit. It finds out what work-related responsibilities (or 'requirements') you must meet to keep getting the benefit in full.

Can I claim benefits for depression UK? ›

If your mental health means you find it hard to work or do daily tasks, you could claim benefits. These will depend on the criteria, but can include depression or anxiety.

How much do you get for PIP 2022? ›

Personal Independence Payment (PIP) is a benefit which has replaced Disability Living Allowance (DLA) for people between 16 and State Pension age.
...
PIP amounts.
2022/23 ratesStandard weekly rateEnhanced weekly rate
Daily living part£61.85£92.40
Mobility part£24.45£64.50

How do you get classed as disabled? ›

'A person has a disability if:
  1. They have a physical or mental impairment, and.
  2. the impairment has a substantial and long-term adverse effect on the person's ability to carry out normal day-to-day activities. '

How many hours can I work on PIP? ›

How many hours can you work to claim PIP? Personal Independence Payment, much like Disability Living Allowance (DLA), is not a means-tested benefit. As such, people can claim it whether they work or not, regardless of the amount they earn. PIP also doesn't change based on the number of hours worked.

What happens if I can't work due to mental illness? ›

If you have experienced employment discrimination because of your mental health condition, you can file an administrative charge or complaint with the U.S. Equal Employment Opportunity Commission (EEOC) or a state or local anti-discrimination agency.

Can I get PIP for anxiety? ›

It is certainly possible to be eligible to claim PIP (personal independence payment pip) if suffering from a mental health condition such as depression or anxiety but it very much depends on how the mental illness affects you.

How much money do you get for bipolar disability? ›

Supplemental Security Income (SSI)

In 2022, the maximum monthly amounts will be: $841 for an eligible individual. $1,261 for an eligible couple (in which both individuals have a disability) $421 for an essential person, also known as a caregiver3.

How long does it take for a work capability assessment decision? ›

It may take four to six weeks after the assessment for you to receive the decision. determines whether you have 'limited capability for work related activity'.

How do I pass a WCA assessment? ›

To pass the WCA, your physical and/or mental health condition needs to affect you 50% of the time. You will be assessed on whether you can carry out certain activities within a reasonable amount of time.

What is the disability element of UC? ›

The main UC element for a claimant with disability (and limited capability for work) is the 'limited capability for work and work-related activity' (LCWRA) element.

Do you get back pay for limited capability for work? ›

If you have been placed in the Limited Capability for Work Related Activity (LCWRA) group, you will usually get extra money on your Universal Credit claim. You may also receive some back payment.

How long does it take for Lcwra decision after assessment? ›

In most cases, the LCWRA element is awarded after a 3 month waiting period beginning on the day you provide medical evidence. If it takes longer than 3 months to carry out your Work Capability Assessment the element you are awarded will be backdated to this point and you will be paid any amount owing.

What are work related activities? ›

"Work-related activities" include activities that are not obviously work but are done as part of one's job, such as having a business lunch or playing golf with clients. Activities are identified as done as part of the job by the respondent during the interview.

What automatically qualifies you for Lcwra? ›

You already get Employment and Support Allowance (ESA)

You'll automatically have LCWRA if you're in the ESA support group. If you already have LCW or LCWRA for ESA you don't need to fill in another form or have a medical assessment for Universal Credit.

Can you work with limited capability for work? ›

If you are receiving ESA, the DWP have accepted that you have limited capability for work or limited capability for work-related activity. There are some circumstances where you can work and your entitlement to ESA will not be affected. This is called permitted work.

Can you get PIP as well as limited capability for work? ›

PIP is unrelated to LCWRA so you can definitely go ahead and apply (if you meet the eligibility criteria), however you would still need to have a PIP assessment.

What happens if I am put in the support group for ESA? ›

If you are placed in the Support Group, the DWP will re-assess your ability to work periodically. This could be up to every three years at maximum. A full list of descriptors and guide to the ESA Work Capability Assessment can be found on the government's website.

Can you get Lcwra for depression? ›

Once the DWP are aware of how your mental health condition is affecting your ability to work or look for work, you may receive LCW or LCWRA automatically.

Does PIP automatically qualify you for Lcwra? ›

If you are pension age and in receipt of Disability Living Allowance (DLA) at highest rate care, Personal Independence Payment (PIP) at enhanced daily living or any rate of Attendance Allowance (AA), you will be awarded LCWRA without the need for work capability assessment.

Can you claim benefits for depression? ›

If your mental health means you find it hard to work or do daily tasks, you could claim benefits. These will depend on the criteria, but can include depression or anxiety. The benefit process can be stressful.

What medical conditions qualify for disability UK? ›

What counts as disability
  • cancer, including skin growths that need removing before they become cancerous.
  • a visual impairment - this means you're certified as blind, severely sight impaired, sight impaired or partially sighted.
  • multiple sclerosis.
  • an HIV infection - even if you don't have any symptoms.

How many points do you need to score to get Lcwra? ›

In order to be put in the LCWRA group you must get 15 points on any one indicator (except in activities 8, 9b, 10 and 15 - 'Finding your way and being safe', 'Consciousness during waking moments', and 'Getting about'). Or meet any of the descriptors in Activity 18 or 19.

What medical conditions qualify for Attendance Allowance? ›

Eligibility
  • you have a physical disability (including sensory disability, for example blindness), a mental disability (including learning difficulties), or both.
  • your disability is severe enough for you to need help caring for yourself or someone to supervise you, for your own or someone else's safety.

How do you know if you passed PIP assessment? ›

Decision letter

The DWP will send you a letter to tell you their decision. The letter confirms whether you will get PIP, which PIP components you get and which rate, and the amount of points you score in the PIP test. Keep the letter in a safe place. You may need to give people a copy when you claim other benefits.

How long after PIP assessment will I get paid? ›

Making a new claim for Personal Independence Payment (PIP) or transferring from Disability Living Allowance (DLA) to the benefit may take up to 22 weeks, according to the latest statistics released by the Department for Work and Pensions (DWP).

How much do you get for PIP 2022? ›

Personal Independence Payment (PIP) is a benefit which has replaced Disability Living Allowance (DLA) for people between 16 and State Pension age.
...
PIP amounts.
2022/23 ratesStandard weekly rateEnhanced weekly rate
Daily living part£61.85£92.40
Mobility part£24.45£64.50

What questions will I be asked at my ESA assessment? ›

They'll ask questions to find out how your health condition, disability or illness affects your ability to carry out a range of everyday activities. They'll also ask you about the things you've said on your questionnaire - take a copy with you so you can check back to the answers you gave.

How do you score 15 points on ESA? ›

You do not have to score 15 points in each activity – it is the total points that matter. You score the points from the desciptor you can not do, if you can not do more than one thing in each descriptor you count the one with the highest points.

Who is getting the 650 payment? ›

The payment is being made to more than eight million low-income households who receive any of the following benefits – Universal Credit, income based Jobseekers Allowance, income-related Employment and Support Allowance, Income Support, working tax credit, child tax credit and pension credit.

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