Consultative Examinations and the Green Book

SSDI Lawyers for Chicago Area Residents

When a disability examiner is going through your Social Security Disability Insurance (SSDI) claim, they may let you know you need a consultative medical exam. If you are concerned about the use of consultative examinations or the green book in an SSDI claim, you can discuss your situation with an experienced Chicago Social Security attorney. The green book provides doctors with important information about Social Security disability programs, how a consultative exam can be requested, what to look for in reviewing consultative exams, and the essential elements of the consultative exam report for those specialties that often require the consultative exam.

Consultative Examinations

The Social Security Administration’s (SSA) Consultative Examination Guide is also known as the green book. The consultative exam is supposed to be conducted by health care providers who understand what the SSA believes are elements of an adequate consultative exam. This exam may consist of medical diagnostic testing as well as neurological and psychological testing. The examiner needs to be licensed and qualified, and must not have sanctions against his or her license. Certain minimum scheduling intervals need to be followed. For example, at least 30 minutes needs to be set aside for an individual appointment for a comprehensive general medical exam. As another example, at least 20 minutes should be set aside for an individual appointment for a comprehensive musculoskeletal or neurological exam.

The provider who performs a consultative exam is authorized only to complete the particular exam or test that the government requests. The provider must perform the test in line with the requirements of the green book. The government’s request might be restricted to a particular test like an MRI or EKG. However, a more comprehensive exam may be requested by the government. If a doctor completing a requested test thinks more testing is needed, he needs to obtain prior approval from the government prior to completing additional testing.

Once a doctor completes the testing that’s needed for your claim, they should file a report. The report should include your identity, medical history, medications you are taking, your family history, your social history, an assessment of your limitations and abilities, a review of your symptoms including negative findings ruled out during diagnosis, results of the exam, and particularized content related to your actual impairment.

Green Book

The SSA has rules related to using an independent source or medical provider for a consultative examination or diagnostic study, and a dedicated SSDI lawyer can answer any questions you may have regarding this process. Generally, it is preferred for a treating source, or a claimant’s own medical provider, to be used for a purchased exam. This preference assumes the treating source is willing, qualified, and equipped to perform an additional text or exam for the fee schedule payment and furnishes timely, complete reports. A treating source is preferred for supplemental testing, too. However, it’s appropriate for the SSA to use an independent source when a treating source doesn’t want to do the exam, when there are inconsistencies or conflicts in the file that can’t be resolved by returning to the treating source, or when prior experience shows that the treating source might not be a productive source.

The types of consultative exams and tests that are purchased hinge on what particular additional information is needed to adjudicate the claim. If an ancillary test would provide the evidence needed for adjudication, a more comprehensive exam will not be requested.

Consult a Skilled SSDI Attorney in Chicago

Many valid SSDI claims are initially rejected, making it advisable to consult a lawyer about your claim. Sometimes insufficient information is available from your health care provider, and a consultative exam may be ordered. If you’re concerned about consultative examinations and the green book, you can call us about your particular situation. At Katz, Friedman, Eisenstein, Johnson, Bareck & Bertuca, we can represent disabled individuals in claims and appeals in Quincy, Aurora, Champaign, and Rockford, and across Kane, Sangamon, Adams, Winnebago, and Cook Counties. We evaluate our clients’ disabilities to determine all possible avenues of relief. Contact us at 312-724-5846 or via our online form.