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Handling gaps in treatment history or refusal of care in your SSD claim

On Behalf of | Apr 15, 2022 | Social Security Disability

When you filed for Social Security Disability (SSD) benefits, you were asked to provide a lot of information – including information about the medical treatment you’ve received for your conditions.

The only problem is that you have some gaps in your care. There were times you didn’t follow your doctors’ orders and times you didn’t go for care at all.

Gaps in care don’t have to be fatal to your claim

The Social Security Administration does look at gaps in medical care very closely. The logic is that “if you’re sick, you naturally should be seeking treatment that could make you better.”

Similarly, the agency assumes that you will follow your doctor’s orders, and can deny your claim if you fail to do so without good reason. They take the refusal to follow a care plan as a signal that you’re not really trying to get well.

However, you can offer an explanation for both these situations that will satisfy SSA and protect your claim. What sort of things count as a good reason for either situation? SSA will accept explanations like:

  • Your financial situation made it impossible for you to afford care or the recommended course of treatment (and you didn’t have insurance coverage that would pay for it)
  • You were physically unable to obtain medical care or follow a course of treatment because the only providers for that care were geographically distant
  • You suffer from mental health issues that were so severe that you were unable, at times, to comprehend the need for treatment or unable to stick to the treatment you started
  • You were told that there was no treatment for your condition that would improve it and the only symptom management you were offered was opiates
  • You were given conflicting recommendations by different doctors and you followed the advice of the doctor you trusted most
  • You were told you needed invasive treatment, like major surgery, that you are either afraid to have (because of the inherent risks) or have a religious objection against

Don’t assume that your Social Security Disability claim cannot be won because of problems with your medical history. An experienced guide can help you address these issues in your claim.