How Might a Gap in Medical Treatment Affect my SSD Case?

Posted March 8, 2019 by Premier Disability Services, LLC®

Medical records are the focus of every Social Security Disability (SSD) 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.

Sometimes in an SSD case, a claimant will stop treating with a doctor. The reasons for the gap in treatment are important. If your medical records are devoid of the reason that treatment stopped, the SSA may assume that your symptoms have improved and that you are no longer disabled. It is imperative that you discuss the reason with your doctor so that it appears in your records.

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 maximum medical improvement and there is nothing else your doctor can do for you. In this instance, the 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 the SSA understands that you are not working and your financial situation may not allow for you to treat. Thus, the 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.

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 three surgeries without improvement it may be reasonable to decide not to have a fourth surgery.

Furthermore, for individuals with a mental disability, it is understood by the 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 that the 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, the SSA can infer that your symptoms are not severe enough to warrant you seeking medical help and, thus, not severe enough to prevent you from working.

If you or someone you know is unable to work due to a medical condition, please contact us for a free evaluation of your claim!

By: Thomas Klint of Premier Disability Services, LLC®