Many times our attorneys at Grimes Teich Anderson LLP speak to potential clients who have applied for Social Security disability benefits but are not receiving regular care for their disabling conditions. The reasons for not seek regular medical care vary from case to case. If you are not seeking regular treatment for your symptoms, Social Security may conclude that your conditions are not as severe as you say they are. In addition, if you are seeking medical treatment but are not following your doctors recommendations, for example, not taking prescribed medication; deciding not to have a recommended surgery; or failing to use a nebulizer, wheel chair or cane as prescribed, Social Security may conclude that your statements regarding your condition are not credible or that you are not doing everything you can to improve your disabling condition.
However, many times there are good reasons that a person is not seeking regular medical care or not following a doctors recommendations. The Social Security Administration has specific rules setting forth when Social Security is not allowed to draw any conclusions about your failure to seek medical treatment or follow recommended treatment. One of the biggest reasons a disabled person is not receiving the medical treatment needed is because they cannot afford the medical care needed. According to a June, 2014 Gallup-Healthways Well-Being poll, 16.8% of South Carolinians remain uninsured. If you are uninsured and no longer working because of a disabling condition, it is hard to imagine a scenario where you can actually afford the medical treatment you need.
Social Security cannot deny a claim based solely on lack of care or failure to take prescribed medication if one is unable to afford proper care and it can be shown that there has been a good faith attempt to seek free or low-cost medical care. In the case Gordon vs. Schweiker, 725 F.2d 231 (4th Cir. 1984), the court made this point by stating that “Social security disability and SSI benefits exist to give financial assistance to disabled persons because they are without the ability to sustain themselves. It flies in the face of the patent purpose of the Social Security Act to deny benefits to someone because he is too poor to obtain medical treatment that may help him.” However, as stated above, even if you can’t afford regular medical treatment, Social Security still wants you to make every good faith attempt to locate free or low-cost services in your area. The upstate of South Carolina is fortunate to have several free clinics and low-cost service options for people. A good starting place to look for these free or low-cost care options in your particular county is the South Carolina Free Clinic Association’s website. Here you can find a list of free clinics available in counties throughout South Carolina that offer services to those individuals who meet the individual clinics eligibility requirements.
Several other acceptable reasons for not getting regular medical treatment include, but are not limited, to the following:
- A prescribed method of treatment would be contrary to the teaching and tenets of a claimant’s religion;
- One of your treating physicians recommends a course of treatment that another one of your treating physician disagrees with;
- You are unable to work because of a condition for which major surgery was performed with unsuccessful results and additional major surgery is recommended or prescribed for the same impairment;
- The treatment carries a high degree of risk because of the rare or unusual nature of the recommended procedure;
- Your mental illness contributes to your refusal to seek needed medical care.
It is important to maintain regular and continuous medical treatment for a disabling condition in order to ensure that you have enough medical evidence to back up your claim for benefits. However, the unfortunate reality is that not everyone can afford the medical care they may need. When seeking Social Security Disability benefits it is therefore important to know when not getting the care you need may negatively impact your ability to qualify for disability benefits. The above list is not exhaustive, so if you believe that you are disabled but have been unable to seek the medical care needed to treat your condition, it is important to talk to an attorney experienced with Social Security Disability laws.
If you believe that you are eligible for Social Security Disability, or if you have been denied Social Security Disability benefits, the attorneys at GRIMES TEICH ANDERSON, LLP, may be able to help.