To be eligible, you need records reflecting appropriate medical treatment for disability benefits. Adequate and continuous treatment is critically important to obtain benefits. When a prospective client contacts our firm about pursuing disability benefits, a common issue we encounter is insufficient records about the prospective client’s medical care, records reflecting sporadic treatment, or records indicating their care is largely unrelated to their disability.
When someone wants to apply for disability benefits, such as Social Security Disability Insurance (“SSDI”) benefits, it is important to understand, and be prepared, for what’s required. For example, disability benefit applicants need to be ready to produce records reflecting appropriate and adequate medical treatment to substantiate that they have a disability. While reviewing a disability benefits application, the Social Security Administration (“SSA”) will examine an applicant’s treatment history to assess whether the disabling condition exists and continues to impact the applicant’s life.
In your medical records, many healthcare professionals provide S.O.A.P. notes (an acronym for Subjective, Objective, Assessment, Plan). These notes document how you are feeling, in addition to your doctor’s objective findings. These types of notes will be thoroughly analyzed by the SSA, in addition to your allegations of disability, to assess whether there is an actual correlation between the two. In other words, if your treatment history does not reflect this correlation, there is a high probability the SSA will not approve your disability benefits application.
Single Visit to the Doctor Generally Insufficient
To have a viable disability benefits application, your medical records need to reflect current, continuous medical treatment. This means if you visited your primary care physician once or twice in the past year, and that is the corpus of your treatment history, the odds of your disability benefits application being approved are close to zero. Your records should reflect adequate, appropriate, and continuous treatment for the disabling condition.
Gaps in Appropriate Medical Treatment for Disability Benefits
Another issue that often arises with medical care is a prospective client who may have visited a doctor or specialist multiple times, but subsequently stopped seeing the doctor for an extended period of time. This is typically referred to as a “gap” in treatment. If you have such a gap in your treatment records, it is important to be able to articulate the rationale for the gap in treatment. Why? Because if your medical records are devoid of a reason for why your treatment was discontinued, the SSA may (wrongly) assume that your symptoms improved and you are no longer disabled. This is why it is so important that you should have a discussion with the treating doctor and they document why you decided not to continue with treatment.
Another significant reason why a discontinuation in treatment needs to be properly documented is because the SSA adheres to specific rules concerning the need to follow prescribed treatment. For example, in accordance with SSA rules and regulations, if an applicant is prescribed treatment and the records indicate the applicant failed to follow the prescribed treatment plan, it provides grounds for denying the disability benefits application.
Attempting to Show Physical Limitations Without Appropriate Medical Treatment for Disability Benefits
In some instances, prospective clients will ask our firm whether it is possible to show physical limitations in their daily life, without an actual record of medical treatment. Generally, the answer is no. In the majority of cases, an applicant will not have a viable benefits application if they don’t have a record of actual medical treatment or a deviation from a doctor’s recommended treatment plan. Your benefits application likely won’t prevail even in instances where you may have a legitimate reason for not following a prescribed treatment plan, such as a religious objective, cost, or disagreement in the recommended course of care.
Standard for Establishing Disability
To be found disabled by the SSA, an applicant needs to provide sufficient medical records to substantiate that they have a “medically determinable” impairment and it is sufficiently severe enough to cause observable functional limitations. This means that simply being diagnosed with, or having complaints of a serious impairment is generally not enough. To meet this standard, an applicant’s treatment history should contain clinically acceptable tests and examinations. In addition, an applicant should have records containing a diagnosis by a legitimate medical source, such as a doctor, physician, specialist, etc. This is why it is so important to be engaged with a medical professional when considering applying for disability benefits. Simply put, an applicant cannot get this type of documentation if they are not actually being treated with a doctor.
Get Appropriate Medical Treatment for Disability Benefits
In sum, to have a viable disability benefits application, do not expect to rely on a single diagnosis or single doctor’s visit. Generally, an applicant needs to be prepared to produce medical records reflecting significant treatment with specialists. Even with sufficient treatment records, there is a risk your disability benefits application may be denied. This is where retaining the services of an experienced and knowledgeable disability benefits attorney in New Jersey can pay dividends.
But first thing first – get the treatment you need. If you have questions, feel free to reach out to our law firm. If we believe you may have a viable disability benefits case once treatment is established, we may recommend you establish a baseline of treatment and circle back with us in 90 days to reassess your viability for disability benefits.
Have Questions About Appropriate Medical Treatment for Disability Benefits? Contact Bross & Frankel Today
If your condition will keep you from working for the next 12 months (at least) then you may be eligible to file a Social Security disability claim and collect disability benefits while your condition renders you unable to work. It will be crucial to obtain appropriate medical treatment for disability benefits to be awarded to you.
Bross & Frankel, P.A. are New Jersey disability benefits attorneys in private practice. We are focused on helping individuals obtain disability benefits and fight to get back to work when something or someone has affected their livelihood. Our experience in advocating for individuals who have found themselves unable to work due to their own health problems gives us a comprehensive set of tools to help get you back on your feet. Contact us online or call us today for a no-obligation claim review at (856)795-8880.