The Disability Application and Gaps in Treatment

It takes a long time to get a disability case heard by an administrative law judge. In many cases, it's taking more than two years from the date of filing to get a court date in the state of Illinois.

Understandably, a lot can happen in that time. Claimants get worse, move, and lose or change insurance coverage. Any number of reasons can result in a significant gap in medical treatment.

While these gaps aren't unusual in disability cases, it's important to document why you haven't sought treatment for some time, as this may negatively impact your case.

The most common reason claimants don't treat is lack of money. The Social Security Administration (SSA) cannot make a negative inference about lack of treatment if it is due to a lapse in insurance or inability to pay for healthcare.

However, it should be noted that since the Affordable Care Act went into full effect and Medicaid is widely available in Illinois, some judges take less kindly to this reason than others.

In mental health cases, sometimes refusal to seek treatment can be seen as an increase in symptoms. This alone also cannot result in a claim being denied.

Simple refusal to comply with treatment is another reason for gaps in coverage. Generally, Social Security looks on this negatively if you repeatedly miss appointments, but in some cases it may be excusable.

Let's say you have already undergone four back surgeries and have seen little improvement. Doctors recommend a fifth, but you refuse it. This would be an understandable reason for a gap in treatment.

Finally, some claimants stop treatment due to reaching maximum medical improvement. This is a double-edged sword as while it means Social Security will make a decision based on all available evidence, a judge also may decide on a closed period of disability that ends with the most recent treatment records.

That's why ultimately if you can't continue medical treatment it's important to keep your attorney informed and document why there's a gap in treatment.

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In Minnesota, we handle Social Security Disability Insurance (SSDI) claims. Throughout the nation, we handle SSDI applications and appeals for people from Ohio to Kansas, North Dakota to Texas and everywhere in between.

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