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What is a consultative evaluation for SSDI in New Jersey?

We have discussed how many chronic illnesses can be debilitating for residents of New Jersey. In many cases, the pain or fatigue related to the illness itself, or to drugs or other treatments for the illness can cause people to be unable to find or keep employment. In such cases, these individuals may be eligible for Social Security Disability Insurance or Supplemental Security Income benefits. We have talked about the basics of filing such applications, but what happens if the Social Security Administration is unable to determine if the applicant is disabled based upon the evidence presented?

If enough evidence is not present for the SSA to approve an application, it may be denied; however, in some circumstances the agency can request more information or schedule a consultative examination. This is a separate medical examination for the purposes of providing whatever information the SSA believes is required to make a decision on the application. As it is paid for by the government, the exam will only include those evaluations or tests that the SSA thinks are relevant.

The agency prefers to have the original treating source provide any consultative examination that may be required. This is, of course, as long as the agency believes that this provider is qualified and has the ability to perform the tests or examination that is necessary. In a few instances, such as if the original provider does not want or isn't able to perform the exam, there are inconsistencies in the original information that are unlikely to be resolved by the original source or if the applicant has a good reason for requesting a different evaluator, the SSA will use an independent source for the consultative evaluation.

If an independent evaluator is appointed, the applicant may be able to object in certain circumstances. While the fact that the SSA will authorize these consultative examinations can help certain applicants, it is likely better to avoid the delay and potential denial of benefits by presenting the most complete information in the first place when one is applying for Social Security disability based on illness.

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