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How to justify gaps in your treatment history to Social Security

On Behalf of | Sep 8, 2022 | SSDI

You’ve been struggling with one or more medical conditions for a while now that have made it difficult for you to continue working. You need to apply for Social Security Disability Insurance (SSDI) benefits.

There’s just one problem: You haven’t exactly been consistent about your medical care. That can lead the Social Security Administration (SSA) to question whether or not you’re truly disabled. Fortunately, that’s not where the evaluation stops.

Social Security will accept a reasonable explanation

When you have gaps in your medical treatment or have chosen not to follow a doctor’s recommended course of action, it’s important to tell SSA why. Every situation is evaluated individually, but SSA will generally accept the following explanations:

  • You’ve sought a second opinion, and it doesn’t agree with the first doctor. This is particularly true when one doctor is recommending a risky surgery or medication that has serious side effects.
  • You’re concerned about opioid addiction. You might be somewhat functional on painkillers, but the risk of addiction is high – and that’s enough to give anybody pause.
  • You were incapacitated for a period. If you have a severe mental disorder, for example, your illness may have prevented you from understanding the need for treatment – or made complying with your medication regime impossible.
  • You couldn’t afford it. There are many treatments that people simply cannot afford, even with health insurance. You shouldn’t be penalized for being unable to pay for recommended care.
  • You have a religious objection. Some religions don’t allow blood transfusions and other medical treatments. If you’re a sincere member of a faith that prohibits such things, that can be taken into account.

It’s not easy to get a Social Security Disability claim approved – but it’s easier when you have experienced guidance with your application or appeal.