Addressing Medical Treatment Gaps In Your North Carolina SSD

In this article, you will discover:

• Whether financial constraints are an adequate explanation for gaps in treatment.
• If a doctor’s letter can help explain gaps in treatment.
• Whether an attorney can help you with explanations for treatment gaps.

Why Do Gaps In Medical Treatment Raise Concerns With The SSA?

The Social Security Administration wants to see consistent treatment because they feel many conditions will improve with consistent treatment. Gaps in treatment leave SSA with no documentation to demonstrate your progress during that period.

Will Treatment Gaps Automatically Lead To A Claim Denial In North Carolina?

It may happen that you are not able to pursue treatment, or additional treatment may not be beneficial. Social Security also recognizes that some medical conditions won’t improve, and therefore, ongoing treatment is not essential.

Are Financial Constraints An Adequate Explanation For Treatment Gaps?

Financial constraints are an adequate explanation for people unable to obtain health insurance coverage. North Carolina did expand Medicaid at the end of 2023. That expansion allowed more people to be eligible for Medicaid and pursue treatment, even with some of the financial constraints.

Given that, getting treatment still requires your ability to get there. For example, this situation can be challenging in rural areas. Treatment also requires you to be able to fill the prescriptions written for you and pay the co-pays when you see the doctor.

Financial constraints also cause you to:

• Pursue treatment less frequently
• Reduce the number of specialist referrals you follow through with
• Be non-compliant with doctors’ recommendations regarding medications and taking everything that’s prescribed

Can A Doctor’s Letter Address Gaps In My Treatment History?

The more information we can get from a doctor, the better. If there’s a gap in treatment due to financial issues, a doctor can adequately explain what they’ve seen in treatment. Suppose the doctor feels additional treatment will not be beneficial and they only need to see you every six months. In that case, having a reasonable medical explanation for the gaps in treatment is helpful.

Attorney David Lund is an experienced lawyer based in Charlotte, NC, who has helped countless clients just like you navigate the intricacies of Social Security Disability law. With over 24 years of experience, he is prepared to assist you with effectively communicating with the SSA to get your disability claim approved.

Still have questions? Ready to get started? Contact Lund Law Carolina today to schedule an initial consultation.

How Can Consulting An Attorney Help With Explanations Of Treatment Gaps?

An attorney can ensure the medical documentation gives an accurate picture of what’s going on. That may entail having a doctor explain why treatment is not as frequent or what restrictions you have, regardless of treatment.

An attorney can help make sure that’s part of the record. They’ll also make sure you know to seek that information and make that part of the conversation with your doctors.

How Do You Prepare Clients For SSA Questioning About Treatment Gaps During Hearings?

I will make you aware that there are places in the record where your treatment doesn’t look like what a judge might like to see. Once you are aware of that, you are more prepared to explain why you didn’t seek treatment. These gaps happened a lot in 2020 and 2021 with the COVID pandemic. People didn’t go to doctors regularly. Those household and financial issues were easy to explain.

Gaps in treatment may be a matter of changing households, making it more difficult for you to travel to the doctor. There might also be a secondary health impairment preventing you from continuing treatment for the primary impairment.

Making you aware in advance of how gaps in treatment look to a judge will prevent you from being caught off guard by questions. The judge is going to ask questions based on what the treatment record looks like to someone else. If an attorney reviews the entire medical history to see what the doctors said, they can craft that explanation for a judge.

Notes From The Field: How Do You Help Clients Stay Calm And Confident During Disability Hearings?

It all starts with preparation: talking with clients in advance so they understand what they’re getting ready to face. If we know the judge, we can give the client an idea of the personality they’re going to engage with and the kinds of questions they can expect to hear.

We need to remain calm on our end as well, so the client knows we’re prepared and their case is adequately situated.

Conversations in advance are the most significant part of allaying client anxieties and making sure we have a successful case that is ready to go before a judge.

Still Have Questions? Ready To Get Started?

For more information on addressing medical treatment gaps in your Social Security Disability claim, an initial consultation is your next best step. Get the information and legal answers you are seeking by calling (704) 412-4773 today.