How a Gap in Medical Treatment Can Affect Social Security Benefits

How a Gap in Medical Treatment Can Affect Social Security Benefits

Medical Treatment Gaps - How Gaps Can Affect Social Security Benefits
How a Gap in Medical Treatments Can Affect Social Security Benefits

When it comes to qualifying for Social Security benefits, the Social Security Administration will look at a number of different factors. They will investigate your medical records to determine if your condition is legitimate. They will also check to see if it meets their definition of a disability. They’ll also look at the statements of the applicant to determine their credibility.

For instance, an individual who claims their back injury prevents them from being able to work. But, they still manage to go the gym to workout on a daily basis is obviously not being truthful. One way that the Social Security Administration will determine the credibility of an applicant is to research any gaps in medical treatment.

What are Gaps in Treatment?

Gaps in treatment are periods of time that you went without treatment despite claiming a medical condition. For example, you claim to have injured yourself in a car accident. But, medical records show that you did not seek medical treatment until six months after the accident. This is an example of a gap in treatment.

The Social Security Administration see such gaps as suspicious. They will often assume that your medical condition must not have been serious enough to seek treatment for it.  And if it’s not serious enough for treatment, then it shouldn’t prevent you from being able to work. Or, live a normal day-to-day life. Meaning there’s no need for disability benefits.

Do All Gaps in Treatment Affect Social Security Benefits?

You should always seek regular treatment if you have a medical condition. However, there are certain situations in which gaps can be explained to the Social Security Administration. The following are some examples of situations in which gaps are justifiable:

  • You lost insurance coverage – Say you received successful treatments for your condition for years while you worked. However, you lost your job and the insurance that you obtained through your job, leaving you unable to continue treatment. You begin treatment again a few months later but are no longer able to work because of your condition. Providing proof that you were without insurance and therefore unable to get treatment during that gap should appease the Social Security Administration.
  • You ran out of treatment options – If you’ve taken several types of medications or undergone several types of treatments (such as surgeries) and they did not help reduce the symptoms of your condition, your health care provider may suggest that there are no other courses of treatment left. If you can provide this opinion in writing, the gap in treatment will not affect your ability to qualify.
  • Treatment isn’t working – If you turn down a treatment option after undergoing several different types of treatments that did not help, your gap in treatment will generally be justified. (If you turn down all recommended treatment, it will not be).

Improving Your Credibility

While you can explain certain gaps in treatment, it can also help your credibility if you had long-term employment before your condition began affecting you (thereby proving you were working steadily), if you showcase symptoms at your hearing or if you attempted to work at different jobs before applying for Social Security benefits before coming to the realization that your condition was preventing you from being able to work effectively.

Gaps in treatment don’t generally look great, but they will be overlooked if you can provide a valid reason for them. For more Social Security benefits tips, call (602) 952-3200 to schedule a free consultation at Social Security Disability Advocates USA.

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