Ohio Social Security Disability And SSI Legal Blog

How do you explain a gap in care on your disability application?

When you file for Social Security Disability Insurance (SSDI) benefits, you have to open up your medical records so that the Social Security Administration (SSA) can see both that you have a disability and that you’re doing your utmost to get better.

That can make gaps in your medical care very problematic since that’s treated as a failure to seek care or follow a treatment plan. What do you do in this kind of situation?

SSA will accept a reasonable explanation for treatment gaps

Fortunately, the Social Security Administration recognizes the fact that there are legitimate reasons for people to go for stretches of time without medical care, so you want to address the issue in your application. 

While SSA will consider any explanation you offer, some of the most commonly accepted explanations include:

  • Cost: Diagnostic tests, doctor’s visits and medications are prohibitively expensive for anybody who lacks health insurance, so it’s not unusual for people to have gaps in care that coincide with lapses in coverage. 
  • Risk: Sometimes, the options you may have for treatment feel worse than the disease. If the only available treatments involve a dangerous surgery, a treatment that has a high potential for risk or the potential for opioid addiction, you can generally justify your refusal to continue your care.
  • Incapacity: It’s not unusual for people who have serious mental disorders to have gaps in care. Their disorder may affect their ability to understand the consequences of not following through on treatment. 

There are a lot of potential issues that can affect your SSDI claim. If you’re having trouble with your application, it may be time to seek legal assistance.