Gap In Medical Treatment And Effects On Social Security Disability Benefits
Medical records are the focus of every social security disability case. The Social Security Administration (SSA) will thoroughly comb through your medical records to assess the extent of your treatment in order to determine the severity of your disability.
In many instances in a social security disability case, a claimant will stop treating with a doctor. The reasons for the gap in treatment are important. If the medical records are devoid of the reason that treatment stopped, SSA may assume that the symptoms have improved and that you are no longer disabled. It is imperative that, whatever the reason, you have discussed the reason with your doctor so that it appears in your records.
Maximum Medical Improvement
If you stop treatment because you have exhausted the many different treatments recommended by your treating physician and there is no improvement in your symptoms, it can be argued that you have reached medical maximum improvement and there is nothing else your doctor can do for you. In this instance, SSA will use all of the relevant medical records to access your eligibility for benefits.
Another reason for ceasing treatment is a claimant may not be able to afford treatment. This is true for many claimants and SSA understands that you are not working and your financial situation may not allow for you to treat. Thus, SSA cannot make a negative inference from your lack of treatment due to inability to access low-cost medical care or not having sufficient health insurance.
Reluctance to Have Surgery
You may have been recommended for surgery by a doctor but you refuse to go through with the surgery. Your refusal to treat in this situation, can be seen as a refusal to comply with medical treatment. However, your medical history and treatment can support your refusal to comply with treatment. For instance, if you have already had 3 surgeries without improvement it may be reasonable to decide not to have a 4th surgery.
For individuals with a mental disability it is understood by SSA that there may be periods of failing to seek treatment. This could be a symptom of your mental disability so failing to seek treatment in this scenario would not, in and of itself, be a deciding factor as to your eligibility for benefits.
Any claimant who has a situation where they have or intend to stop treatment must ensure their reasoning is a valid reason for which SSA will accept and not hold against you. After all, your medical records are the source of accessing your credibility, as well as the nature and extent of your disability. Without this information SSA can infer that your symptoms are not severe enough to warrant you seeking medical help, thus it is not severe enough to prevent you from working.
By Patricia Zeleznik