616.Consultative Examinations

616.1When do you need a consultative examination?

We may require a consultative examination in situations including, but not limited to, the following:

  1. To gather more evidence because the evidence obtained is not enough to make a disability determination;

  2. To obtain more detailed medical findings about your impairment(s);

  3. To obtain technical or specialized medical information;

  4. To resolve conflicts or differences in medical findings in the evidence already in file; or

  5. To resolve the issue of your ability to do substantial gainful activity, if you are an adult; or, if you are a child under age 18, your ability to function like other children your age who do not have impairments.

We pay for necessary consultative examinations.

616.2Who administers the consultative examination?

Your medical source will be the preferred source to perform the consultative examination. However, we may use a different medical source other than your medical source in certain situations. In some situations, we pay travel expenses relating to a medical examination required in connection with a disability determination.

616.3What happens if you refuse a consultative examination?

If you refuse a consultative examination without good cause, we make a decision based only on the evidence in your file.

Last Revised: Apr. 19, 2017