CE's Proved Unnecessary

We recently represented a 59-year-old phlebotomist from Smithtown living with chronic obstructive pulmonary disease (“COPD”), essential tremors, chronic pain, and several other serious medical conditions. Before retaining our office, she had applied for Social Security Disability benefits on her own and was denied twice.

Because she had already completed consultative examinations through the IMA Disability Services during her prior applications, we filed a new application for her in April 2025. This time, we focused on gathering and submitting comprehensive medical records and detailed summaries from her treating physicians — the doctors who know her history best, and whose consistent opinions carry significant weight under Social Security’s rules. With this evidence, we secured a fully favorable decision in just four months.

This case highlights how experienced legal representation can make a meaningful difference in the disability process. Understanding what Social Security looks for, and how to present the strongest evidence, can be the key to moving from repeated denials to a timely approval.

If you are facing challenges with your own disability claim, our office is here to guide you through the process and fight for the benefits you deserve.  Our office, located in Melville, NY, offers a free phone consultation.

"Let's Get Loud" Series - DDS's Laziness

by Susan Golden

Claimant 4 – Consultative Exams ordered by the State agency

Ms. G  applied for SSD benefits on June 26, 2024.  Ms. G was an elementary school teacher for 33 years.  She suffers from severe migraines, vertigo, severe back problems and anorexia, to name a few of her impairments.  On August 5, 2024, we submitted supporting medical reports from Ms. G’s treating doctors, which included an EMG and a pharmacy printout.

On August 22, 2024, my assistant, Samantha Diamond, received a phone call from Mr. Begelman, the analyst at the State agency assigned to Ms. G’s case.  He was calling to advise us that he was scheduling Ms. G. for a Consultative Exam (“CE”) with the IMA, the company that SS contracts with to perform CE’s.  According to the regulations, CE’s are supposed to be scheduled only after making best efforts to obtain the necessary information from the treating sources, which are the preferred source.  When Ms. Diamond asked Mr. Begelmann= if he had reviewed Ms. G’s file and seen what we submitted, he admitted that he hadn’t even looked at the file yet.  So without even knowing what was or was not needed, and without doing the bare minimum required by the regulations, Mr. Begelman scheduled Ms. G for a CE with IMA.

Notably, most of the time the “specialists” at IMA are from the wrong medical board, if they are certified at all, let alone trained in the specialty that is relevant to the claimant’s impairments.  Additionally, IMA doctors claim they do not have any records or information from the State agency about claimants, which begs the question, how do they know what exam to perform?  IMA also has signs all over their offices which state that Social Security claimants are not allowed to record their exams, yet in small print on the same sign it states that Workers’ Comp claimants are allowed.  That disparate treatment is ridiculous, and if our claimant tries to record an exam, the IMA employees cry that their HIPAA rights are being violated.  HIPAA only applies to a person’s medical information - it provides no rights, and has no relevance, to IMA staff.  Since IMA admits to allowing Workers Comp claimants to record exams in the very same offices where the SS claimants are being examined, by the very same staff, and the very same doctors, then IMA must be confessing to countless HIPPA violations.

IMA Disability

I used to surmise that the State agency has an unwritten regulation that requires it to insist that every Social Security Disability (“SSD”) claimant attend a consultative examination (“CE”).  I have to come realize that because the State agency examiners and medical consultants are too lazy or too busy to read the claimants’ file, they disregard all the medical evidence in the file, and simply rubberstamp whatever CE concludes.  Therefore, the State agency sends letters to claimants requiring them to attend CEs by IMA.

When attending CEs, we have our clients confirm that the IMA doctors do not review any medical records.  Thus, the State agency does in fact ignore all the medical evidence in claimants’ files other than the CE report.

We represent a 60 year old teacher assistant from Brooklyn with physical and mental impairments.  The State agency sent a letter to the claimant to attend two, not one, IMA CEs.  I sent a letter asking the State agency to explain how the scheduled CEs complied with the regulations.  I never received a response to my letter, but a couple of weeks later, the State agency notified us that the claimant’s  SSD application was approved.

Before we agree to represent our clients, we always emphasize how important it is for them to speak with their doctors to confirm they will support the client's inability to work full time.  As soon as we file an application for SSD benefits, we request the client's medical records, and submit them as soon as possible after obtaining them.

 

 

 

IMA

The Social Security regulations identify the limited circumstances when a person seeking Social Security Disability (“SSD”) benefits should be sent for a consultative examination (“CE”).  However, upon receiving an SSD application, the knee jerk reaction of our State agency is to tell a claimant they must go to Industrial Medicine Associates (“IMA”) for a CE by an unnamed person, for an unspecified reason.

One of our former clients, an insurance representative from Brookhaven, came back to us after a continuing disability review (“CDR”) resulted in her SSD benefits being terminated.  When we appealed, the State agency sent the usual demand for a CE by IMA.  We explained why the CE would be inappropriate, and the State agency specified what additional medical information was needed, which we supplied from the claimant’s specialists.  Shortly thereafter, the claimant’s SSD benefits were reinstated.

Even though our client had not needed our services for over 10 years, she knew she could contact us to help her again, and was confident that we could get her benefits reinstated.    Needless to say, she is very happy and grateful that we were able to help her again.

Dire Need

According to Social Security, a dire need situation exists when a claimant alleges any of the following circumstances:

• The claimant is without food and is unable to obtain it.
• The claimant lacks medicine or medical care and is unable to obtain it, or access to necessary medical care is restricted because of a lack of resources.
• The claimant lacks shelter (e.g., without utilities such that their home is uninhabitable, homelessness, expiration of a shelter stay, or imminent eviction or foreclosure with no means to remedy the situation or obtain shelter).

Absent evidence to the contrary, accept a person's allegation that the person does not have enough income or resources to meet an immediate threat to their health or safety.  HO employees will err on the side of designating the case critical.

Despite the above, many requests to have a claim classified as a dire need case are ignored by the assigned analyst.

We represent a 58 year old with multiple foot, spine and wrist problems from Valley Stream who worked as an electrician.  We were able to obtain strong evidence from the claimant’s pain management specialist.  The claimant qualified as a dire need case because his utilities were being shut off.  However, the case was languishing because the analyst was holding dire need status hostage.

The analyst refused to tag the case as a dire need because he wanted to the claimant to attend a consultative examination (“CE”) with IMA. We had to escalate the matter above the analyst’s head, who claimed there was nothing he could do.  We succeeded in getting the supervisor to expedite the case, which was approved in about 10 days, without the need for a CE.

The claimant is so happy that he retained us, and that we had the experience and knowledge to do what was needed to get his claim expedited.   This is just another of many reasons why you should retain an experienced disability attorney to represent you if you plan on filing for Social Security Disability benefits.   If we hadn't known what to do, our claimant's case would still be sitting there.

If you are planning on applying for Social Security Disability benefits, please call our office for a free phone consultation at (888) 572-0861.  Our offices are conveniently located in Nassau and Suffolk counties on Long Island.

 

IMA & DDS

The questionable relationship between IMA and the State agency  continues, without any meaningful oversight.  It seems nobody is concerned about the thousands of unnecessary exams.

We were retained by a 55 year old pharmacy tech from West Babylon with progressive orthopedic impairments following a motor vehicle accident, after her Social Security Disability (“SSD”) application was denied.  As usual, the claimant was sent a letter stating that it was “necessary for” her to be examined by an unnamed doctor from IMA Disability Services.

In light of the persistent COVID-19 pandemic, we advised the State agency that it was more important now than ever to comply with the regulation concerning a consultative examination (“CE”).  After all, according to Social Security’s website, they continue to conduct many hearings by telephone due to COVID-19.  We advised the State agency to make a decision because the claimant was not willing to postpone a CE with IMA.  Additionally, we advised the State agency that whatever information it believed was needed from IMA, could be requested from the claimant’s medical sources, who are the preferred source pursuant to the regulations.

The claimant did not attend a CE with IMA.  We received a Notice of Award today for the claimant, who provided all her medical records and reports from her doctors.  The State agency’s motivation for disregarding the CE regulations remains unclear.  However, it is clear that the State agency’s letters asserting the IMA CEs are “necessary” is untrue.  The claimant’s application should never have been denied in the first place.

 

Wasteful & Inequitable CEs

We represent a 53 year old business owner from New Rochelle with physical and mental impairments, whose Social Security Disability (“SSD”) application was approved today.  Last month, the claimant was warned that his failure to attend a consultative examination (“CE”) with IMA could result in his application being denied.  Due to COVID I had advised the claimant not to attend the CE.  It seemed hypocritical to me that Social Security district and hearing offices were closed due to COVID, yet the State agency wanted claimants to be physically examined at IMA offices.

Three non-for-profit institutions just published a position paper about their investigation into CEs that IMA performs.  The position paper discusses the various complaints that I have been posting about for many years now.  The position paper can be found on my Resources tab, and I would encourage anyone applying for SSD benefits to read it

State Agency Notices

Some things never seem to change.  In 2018, I wrote about a persistent problem that claimants face when applying for Social Security Disability benefits.  In 2019, I wrote how the State agency sends claimants a letter stating that “it is necessary” to be examined by a doctor from IMA Disability Services (“IMA”).  However, these consultative examinations are rarely “necessary.”

According to Merriam Webster, “necessary” means required.  However, under the regulations, the State agency rarely meets the criteria for a claimant to submit to a consultative examination by IMA.  For years I have been asking for an investigation into the IMA boondoggle, but that request has fallen on deaf ears.

We represent a 56 year old from Great Neck with orthopedic problems and prostate cancer, who had worked as a security supervisor.  He received six (6) letters from the State agency insisting that

“IT WILL BE NECESSARY FOR YOU TO BE EXAMINED BY THE SPECIALIST NAMED BELOW,” which was IMA.  The claimant was approved today without having needed to attend a hearing, and without having been examined by IMA.  These misleading State Agency letters should stop.

If our client had not retained us, he would presumably have attended those examinations, and wouldn’t have known that he wasn’t required to go to them, and the outcome could have been very different.   You should plan on retaining a disability attorney if you are thinking about applying for SSD.  Your attorney has your best interests at heart; Social Security does not.  Please call one of our Long Offices for a free phone consultation.  We have offices located in both Nassau and Suffolk counties.

NYS OTDA

The New York State Office of Temporary & Disability Assistance (“OTDA”) continues to order Social Security Disability (“SSD”) claimants to be examined by IMA Disability Services for consultative examinations (“CE’s”) under questionable circumstances. 

The regulations state that OTDA may decide a CE is needed, but only “If we cannot get the information we need from your medical sources.” The OTDA ignores the regulations. On a continuing and regular basis, the OTDA orders claimants to go to IMA for a CE without any attempt to obtain any information from claimants’ medical sources. 

We filed an SSD application for a 32 year old salesperson from East Meadow with mental impairments. A few weeks later, the OTDA insisted that the claimant attend an IMA CE, even though we had already provided disability reports and narrative medical summaries and explanations, from the claimant’s psychologist. The OTDA never made any written or oral request for records from the claimant or his doctors, which we also provided. 

We objected to the CE. We asked that the OTDA identify what additional information they contended had not been submitted, and that we would ensure that the claimant’s doctors would provide it. As usual, the OTDA ignored our letter, simply sent another notice that ordered the claimant to attend to the CE. In response, we told OTDA that any CE needed to obtain additional information would have to be conducted by telephone because he has agoraphobia. OTDA said they would see what their doctor said about the agoraphobia. 

We did not hear back from OTDA about the CE. However, the OTDA did approve the claimant’s SSD application. 

This is another example of why it is beneficial to be represented by an attorney who specializes in disability law when you file a claim for benefits. I have helped thousands of clients obtain SSD benefits, many of whom would have been denied. Please feel free to call my office for a free phone consultation. We have offices conveniently located on Long Island in Nassau and Suffolk counties.

Videotaping IMA

When applying for Social Security Disability (“SSD”) in New York, Industrial Medicine Associates (“IMA”) has been performing the consultative examinations (“CEs”) for the State agency for many years now. One of the reasons to videotape IMA CEs is to preserve first hand evidence.  As an SSD attorney, I advise all of my clients to videotape their CEs for this very reason.

I represent a 23 year old former clerical assistant with rheumatoid arthritis and a knee injury. An administrative law judge (“ALJ”) approved her SSD application today, which would have been denied if the IMA CE had not been videotaped. 

The State agency initially denied the claim by disregarding everything the treating specialist concluded, and by having its doctor, Verdella Cincore, claim that the IMA CE report showed the claimant was not disabled. 

According to the New York State Department of Health, Cincore is an ob/gyn, who lacks any board certification. The American Board of Medical Specialties also confirmed that there is no physician named Cincore in the United States who is board certified in any field of medicine. Dozens of websites, including Good Samaritan Hospital, Healthgrades, Doximity, Zoddoc, NPI, HIPAASpace, Medcarelist, all state that Cincore holds herself out as an ob/gyn. According to medicinenet.com, “OB is short for obstetrics or for an obstetrician, a physician who delivers babies. GYN is short for gynecology or for a gynecologist, a physician who specializes in treating diseases of the female reproductive organ.” It should be obvious that an ob/gyn is not the appropriate specialist to evaluate the claimant’s impairments, which have absolutely nothing to do with delivering babies or the female reproductive organ. 

The IMA doctor diagnosed the claimant with complex regional pain syndrome, rheumatoid arthritis, and hypothyroidism, which he wrote resulted in “Moderate to marked restrictions with walking, climbing, kneeling, squatting, bending, and prolonged standing.” However, the videotape of the CE revealed the IMA doctor unambiguously stating that the claimant should get disability benefits, and that it would be unreasonable if she did not get SSD benefits. In the absence of that videotape, the ALJ would have stated that the IMA doctor concluded the claimant could perform sedentary work, and would have denied the SSD application.

NYS OTDA & IMA

On March 26, 2019, I received a letter from the New York State Office of Temporary and Disability Assistance (the “State agency”) that said “it is necessary for [my client] to be evaluated by one or more of our doctors.” Previously, the State agency had sent four other letters stating that it was necessary for the claimant to be examined by IMA Disability Services (“IMA”). 

My client is a 61 year old former nursing assistant with various musculoskeletal problems. Her application for Social Security Disability (“SSD”) benefits was approved today without a hearing. While the claimant went to IMA, the exam was not completed because she insisted on video recording it. 

New York State has one of the highest, if not the highest, rate of SSD claimants being sent for exams by State agency doctors. The excessive boondoggle should be investigated because there are thousands of SSD claimants being sent for exams that are NOT necessary.

IMA

In New York, the State agency uses IMA Disability Services (“IMA”) to perform consultative examinations ("CEs”).  I represent a 57 year old probation officer with a bad back and ocular albinism, who received four letters from the State agency stating that it was “necessary for you to be examined by” IMA. The letter emphasized that the claimant “must keep this appointment at the time and date indicated above.” 

Despite the mandatory language in the CE letters, the CE was not imperative. Sometimes the State agency representative is amenable to cancelling a CE if they receive certain medical information. That was the case with this claimant, whose Social Security Disability application was approved today, after we negotiated providing the State agency with medical information in response to a particularized request.

Recording A CE

Regardless of what the medical records reveal, the State agency tells a Social Security Disability (“SSD”) claimant to go for consultative examinations ("CE”). CEs almost invariably contain fraudulent findings. For example, the CE report will say that the claimant had no trouble getting on and off the exam table, when the claimant only sat in a chair. This has been happening for many years.

To guard against fraudulent findings, I advise my clients to video record the CE, which are performed by ­IMA. Because there is no law, rule, or regulation that prohibits a SSD claimant from recording the CE, IMA claims that it is against their policy. However, in IMA offices, they have signs stating that claimants can record their exams, so their “policy” is specious at best. 

I represent a 52 year old former teacher for the deaf whose SSD application was approved by an ALJ today. The State agency had denied the claim on the grounds that the claimant refused to attend the CE. The claimant testified that when the IMA doctor saw the claimant’s spouse recording the exam, the doctor threw a fit, left the exam room, and refused to return. The claimant further testified that she never refused to answer any question or submit to an exam by IMA. If the reports of IMA doctors actually reflected what transpired during their exams, then there would be no reason for IMA’s “policy.”

IMA Disability Services

Don’t believe everything you hear; especially when it comes from IMA Disability Services (“IMA”).

I represent a 58 year old construction foreman, whose job was very heavy work. He had rheumatoid arthritis and carpal tunnel syndrome, which prevented him from continuing to work. As usual, the State agency directed the claimant to attend a consultative examination (“CE”). 

I advised my client to videotape the CE. Two weeks ago, he went to the IMA office in Bohemia with his wife, who was videotaping the entire CE process with her cell phone. He was taken for an x-ray before the physical examination. Before the x-ray was taken, an IMA representative told the claimant that he was not allowed to record the CE. When the claimant insisted that he had the right to videotape his own exam, he was told that the CE would not proceed and to leave. 

As the claimant was leaving IMA, he was told that he would be back the next week. The claimant never returned to IMA, and he received his Social Security Disability (“SSD”) check in the mail today.

Treating Doctor CE

The Social Security Administration (“SSA”) invariably sends notices to applicants seeking Social Security Disability (“SSD”) benefits stating that they to attend a consultative examination ("CE”). In New York, claimants are told they have to be examined by a doctor from Industrial Medical Associates (“IMA”). However, the SSA’s program operations manual system (“POMS”) states that a claimant’s own medical sources should be asked to perform the CE for the back problem. 

When my clients get notices for an IMA CE, I advise the State agency about the relevant POMS, and offer to have the claimant’s doctor perform the CE and provide a detailed written report. To ensure there is no issue regarding the quality of the report, I tell the State agency to specify exactly what they would like the report to include, and to provide me with the same information they send to IMA when asking it to conduct a CE. 

Several disability analysts have recently agreed to allow claimants’ doctors to perform CE in lieu of IMA. In each instance the claim has been approved. One of those cases involved a 49 year old former Director of a State agency whose primary impairments are Lyme disease and fibromyalgia. Both conditions are frowned upon by the State agency, which invariably denies SSD applications based on those conditions. Nonetheless, shortly after the claimant submitted the CE report from her doctor, the SSD application was approved.

IMA CE

The State agency continues to send letters insisting that Social security Disability (“SSD”) claimants go to consultative examinations (“CEs”) by Industrial Medicine Associates (“IMA”). I represent a 59 year old former security guard with breast cancer and orthopedic problems whose SSD application was approved today, even though she did not go to the IMA CE. 

The State agency was unconcerned about the cancer because it was Stage I. Nonetheless, the claimant had three separate orthopedic specialists who treated her bilateral hand, lumbar spine, and knee problems. Their treatment records and supporting summary reports with functional assessment were obtained quickly. The same State agency that said it was necessary for the claimant to attend a CE, determined that the claimant was disabled from work, despite the fact that she did not attend the IMA CE. 

Ongoing communications with the State agency representative assigned to the claim helped expedite the case. We were able to pin down exactly what the State agency claimed would be needed from the CE, and had the claimant’s doctors’ provide it. Getting the information made the representative’s job easier as we did the job for her. Avoiding the IMA CE with its inevitable conclusion that the claimant could work made the extra effort worth it.

Pontine Stroke

According to reference.com, a pontine stroke is one that occurs in the pons, which is a portion of the brain stem. The pons, which is located between the midbrain and medulla, relays messages between the cerebral hemispheres and cerebellum. Common symptoms include double vision, dizziness, vertigo, slurred speech and imbalance. 

Being disabled from a condition that is somewhat atypical may have helped one of my client’s get approved for Social Security Disability (“SSD”) benefits. The State agency usually requires claimants to attend a consultative examination (“CE”) that its contracted doctor performs. CE opinions are almost always less supportive than treating doctor opinions. 

I represent a claimant who suffered from a pontine stroke. The State agency wanted to send the claimant for a CE to Industrial Medicine Associates (“IMA”), which I objected to for several reasons. On this occasion, the State agency agreed with my request that the claimant’s treating doctor perform the CE. 

The treating doctor’s CE report stated that the claimant suffered from slurred speech, imbalance, spasticity and right sided weakness, including abnormal gross and fine manipulation. The CE report also provided a less than sedentary work ability. The State agency approved SSD benefits after receiving the report. 

Treating doctors frequently supply opinions that claimants possess less than sedentary work abilities to the State agency, but those opinions are usually rejected in favor of the IMA opinion, or are simply rejected on the grounds that determination of disability is for the State agency to make. It may be possible that because the claimant’s problem was somewhat unusual, IMA lacked a proper doctor to do the CE, and therefore, the State agency agreed to allow the treating doctor to do the CE.

Kudos To ALJ Wexler

I represented a former valet with cardiovascular problems whose claim for Social Security Disability (“SSD”) benefits was approved today by Administrative Law Judge (“ALJ”) April Wexler. Unfortunately, the claimant died on February 27, 2016, from those health problems. 

The Social Security Administration (“SSA”) had insisted that the claimant attend a consultative examination (CE”) by Jerome Caiati, a doctor who claims to be an internist working for IMA Disability. According to the American Medical Association, American Board of Medical Specialties and New York State Department of Health, Caiati did not attend medical school in the United States, and is not board certified in any medical field. That fact alone should suffice to accord little weight to Caiati’s opinion. 

As discussed in my prior postings, the IMA CEs are frequently baseless. Some of my colleagues believe that the Caiati CE reports are the worst of all. ALJ Wexler’s decision is consistent with that opinion. 

Caiati diagnosed the claimant with history of "asymptomatic" hypertension/high blood pressure, while cautioning the claimant to follow up with his own physician after the CE revealed elevated blood pressure. As he virtually always does, Caiati opined that the claimant had no limitations in sitting, standing, walking, reaching, pushing, pulling, lifting, climbing, and bending. 

ALJ Wexler gave Caiati's opinion little weight because it was not only inconsistent with the record as a whole, but with is own CE findings as well. For example, the ALJ pointed out that the claimant could not only have a "history" of high blood pressure, implying that it was a thing of the past, while Caiati admitted that the claimant currently had high blood pressure, and even warned that the claimant had to follow up with his own physician. ALJ Wexler added that high blood pressure is etiologically related to the claimant's fatal cardiac failure. 

In rejecting Caiati's opinion, ALJ Wexler concluded that, “It strains credulity that, given the claimant's significant medical history and the positive examination findings for high blood pressure, the claimant would have had absolutely no physical limitations as opined by Dr. Caiati.” 

I am surprised that the ALJ gave any weight to Caiati's opinion at all. Anyone whose SSD application was denied based upon a CE by Caiati should file an appeal.

Holding IMA Accountable

We represent a claimant for Social Security Disability ("SSD") benefits. His claim was approved today without a hearing, even though Social Security rarely does this anymore. 

We had filed a request with the Freedom of Information Act (“FOIA”) when the claimant attended a Consultative Exam (CE) at IMA in January, only to be told when he got there that the doctor wasn't in. We filed the FOIA request because we wanted to show that fraud was being committing, as they denied our client his SSD benefits initially for not attending the CE. Our FOIA request was denied. The evidence in other cases was just as strong, so we can only assume that Social Security did not want to have to explain why IMA lied regarding the CE. The bottom line, do not let IMA lie.

IMA Folly

I represent a 60 year old former institutional cook whose Social Security Disability (“SSD”) application was approved today, but not before IMA Disability Associates (“IMA”) sent over a half dozen letters insisting that he must attend a consultative examination (“CE”). My client did not. 

On October 22, 2015 and October 23, 2016, the State agency sent letters stating that the claimant “must” attend a CE because it was “necessary” for him to be examined by IMA. Both letters were received on October 26, 2015. That day, I faxed the State agency a detailed seven page letter explaining the reasons why scheduling a CE with IMA was improper. My letter specified that the claimant was not refusing to attend a CE, but asked the State agency to address the questions raised in my letter raised first. 

On November 5, 2015, the State agency refused to address the issues raised in my October 26, 2015, and said that this was the claimant’s last chance to attend a CE. The State agency then send another notice on November 10, 2015, reiterating that the claimant “must” attend a CE because it was “necessary” for him to be examined by IMA. On November 12, 2015, I replied that the claimant would attend the CE as soon as the State agency responded to the matters raised in my October 26, 2015 letter. 

The State agency continued to refuse to cooperate, and instead, on November 16, 2015, sent yet another CE notice stating that the claimant “must” attend a CE on November 16, 2015, because it was “necessary” for him to be examined by IMA. On November 18, 2015, I faxed the State agency we received their letter on November 17, 2015, the day after the CE was scheduled. Moreover, I advised the State agency that I sent them a detailed report from the claimant’s pain management specialist, together with a lumbar spine MRI, which obviated any supposed need for the CE. I added that if they believed otherwise, then respond to each of the matters raised in my October 26, 2015 letter. 

The State agency never attempted to address any of the issues raised in my October 26, 2015 letter, and it did finally approve SSD benefits, but the claimant never went to IMA for a CE. The question is, why does the State agency keep telling claimants that claimants “must” attend IMA CEs when that is not true.