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How Gaps in Medical Treatment Affect SSD Benefits

There is no question that the process for applying for disability benefits and having them accepted is a long one. During that time, it is not uncommon for issues that can affect the outcome of the claim to arise. One of the most common issues of this nature is having a gap in medical treatment. The information below will help you understand what a gap in medical treatment is and how it can affect your Social Security disability (SSD) benefits.

Gaps in Medical Treatment

What is a Gap in Medical Treatment?

A gap in medical treatment occurs when there is a significant length of time between instances when you were treated by a doctor or other medical professional for your condition. Sometimes there are legitimate reasons for a gap, such as moving to a different geographical area, loss or change of insurance or lack of money. Although it is common to have gaps in medical treatment, it is necessary to document the reasons as part of your disability claim.

Acceptable Reasons for Gaps in Medical Treatment

Often there are legitimate reasons for gaps in your medical treatment. Life happens, and sometimes there is no way to anticipate the death of a loved one or a sudden change in life’s circumstances. It is understandable that an unexpected event, or even something like a planned vacation, may cause you to miss a doctor’s appointment or a few therapy sessions. Issues such as these that cause minor gaps in your treatment will have no bearing on the acceptance of your disability case. But, it is crucial to your case that you explain to your doctor why you have to miss an appointment. Your doctor can then notate the reason in your medical records. Also, make sure you can clearly explain to the judge any reasons for missed appointments in case the doctor forgets to mark it in your records.

Refusal to Seek Treatment

Refusing to comply with your doctor’s prescribed treatment methods or repeatedly missing doctor’s appointments can lead to gaps in treatment. The Social Security Administration (SSA) takes a harsh look at these cases and will often deny a disability claim if this is the reason for a gap in treatment.

Mental Health Cases

For those who seek disability benefits because of mental health issues, refusal to seek treatment is often considered a symptom of the illness. In cases like this, a claim cannot be automatically denied due to a gap in treatment.

Reaching Maximum Medical Improvement

Many medical conditions have a level at which no more medical improvement is possible. If you have reached this point in your condition, it is feasible to believe no more treatment is necessary, as it will not improve the condition. The SSA will be able to make a determination based on the evidence you provide. However, it is possible that a judge will base a decision on a shorter period of time that ends with your last recorded treatment. Ending your treatment after your doctor says you have reached maximum medical improvement (also known as “finalized”) can lose out on thousands of dollars in disability benefits.

Palliative Care

Once you reach your maximum medical improvement stage, your next step is palliative care. Palliative care focuses on pain relief from permanent symptoms or injuries. The goal of palliative care is to slow down degeneration and improve the quality of life of a patient. Palliative care is also essential for keeping function and mobility at a high level and prevent setbacks.

If you have questions about gaps in medical treatment and how they can affect your SSD benefits, contact the law office of Daniel Berger today. We are here to help you.

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