Any time you go for a long time between doctor visits without any sign that you're actively seeking a way to improve your condition, it can seriously damage your ability to win Social Security disability benefits. Learn why a lapse in treatment is a problem, and what you can do to minimize its impact on your case.
Why Are Gaps In Treatment Fatal To Your Disability Claim?
It's presumed that nobody wants to be sick or in pain. Therefore, gaps in time where you weren't seeking medical care can affect the credibility of your claim.
The logic from the view of the Social Security Administration is that you either:
- weren't as sick as you claimed,
- weren't trying to get better, or
- had a period of time in which you were not disabled because the condition was in remission.
Otherwise, you'd be hounding your doctor and beating down the doors of specialists, as an alternative to being on disability, right?
In reality, many people experience lapses in medical care because they:
- can't afford treatment,
- have been told there is nothing additional that can be done, or
- have reached a point where they feel hopeless about their condition and give up.
Of course you'd rather be healthy and working. But, how do you prove that to the Administrative Law Judge (ALJ) at your hearing?
You Can Still Win Your Case - If You Are Prepared.
Your case is by no means hopeless if you have a lapse in medical care, but you want to address the issue with your attorney well before the hearing in front of the ALJ. This gives your attorney time to address the situation with you and possibly correct it.
Many disabling conditions are chronic and hard to treat. That's why it can become very easy to fall into a pattern of simply trying to manage your condition as well as you can, without engaging in the frustration of fruitless doctor visits. Or, you may have already tried all the available treatments and found them unsuccessful for some reason. There might be nothing new to try right now.
In order to prove that this is your situation, contact your doctor. Ask him or her for a letter that describes your condition and its chronic nature. In addition, the letter should state that the lapse in care didn't indicate a period of recovery - that it actually reflects a period of time where no additional medical treatment (other than medication) was prescribed or available.
If you've stopped seeking treatment because you feel hopeless about your condition, you need to discuss this with your attorney and your physician. You may be suffering from symptoms of depression, which isn't unusual among people who have debilitating medical problems.
If that's so, you need to be treated for the depression, and your attorney needs to develop evidence of the condition, because it should be considered as a factor by the ALJ when deciding your claim.
If you've stopped receiving medical care because you can't afford it, your attorney may be able to guide you through the process of obtaining free or reduced-fee medical care in your area. At the very least, your attorney can help you prepare how to explain to the judge that you are financially unable to afford medical care.
It's not hard to understand why lapses in medical care occur from the patient's point of view, but you increase your odds of being approved if you are able to put the situation into words for the judge. Ask an attorney like Allison Tyler Attorney how you should respond to questions about lapses in care, so that you maximize the odds that your case will be approved.