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What if I Cannot Afford to See a Doctor for My SSDI Claim blog header image

What if I Cannot Afford to See a Doctor for My SSDI Claim?

Without an endorsement from a medical professional, it is nearly impossible to qualify for disability benefits. However, seeing a doctor can be expensive, especially for those who are uninsured. If you feel that you could qualify for SSDI but cannot afford medical treatment, there are some solutions. 

SSDI Requirements

To receive Social Security Disability Insurance (SSDI)  benefits, you must meet Social Security’s qualification requirements. A major requirement is that you have sufficient medical evidence of your disability. This evidence is any documentation of your condition made by medical professionals. 

See: The full 5 step SSDI qualification process

Why is Medical Evidence a Requirement? 

The purpose of gathering medical evidence is so the Social Security Administration (SSA) can determine the severity of your condition. Another SSDI requirement is that your condition must be severe enough to keep you from working for at least twelve months. A disability examiner at the SSA will review the evidence you submitted to determine if you meet this requirement. If you do not provide a sufficient amount of evidence, they will be unable to determine if you meet the requirement and deny your claim. 

Disability examiners also often gauge the severity of a condition based on the frequency that the claimant visited the doctor. Lack of consistent medical treatment can reflect a non-sever medical situation, in the eyes of the SSA. 

Although, in many cases, it is common that the frequency that a claimant visits a doctor does not reflect the severity of their disability, rather their financial abilities. 

What if I Cannot Afford to Regularly See a Medical Professional? 

If you are lacking in medical evidence and consistent medical treatment, it is likely that a disability examiner will look at your application to understand why this may be. The SSA requires that their examiners account for all situations that could cause a lack of treatment, including financial issues. 

If you are unable to afford consistent medical treatment, you can strengthen your claim by providing evidence that you attempted to get treatment that is within your means. This evidence could be 

-Visits to urgent cares or emergency rooms instead of a regular physician. 

-An application for Medicaid benefits. 

-Any documented attempt of searching for low cost medical treatment or payment plans with a doctor’s office.

In addition to investigating why a claimant may have inconsistent medical treatment, the SSA will also likely offer a Consultative Examination. 

Consultative Exams

The SSA cannot outright deny you benefits if you cannot afford medical treatment. If you are unable to see a doctor due to financial issues, and therefore lack medical evidence, the SSA will likely offer for you to have a Consultative Examination (CE). 

A CE is a medical exam that Social Security pays for in full. If your treating doctor has the equipment to perform a CE the SSA may ask them to do it. However, they are able to say no to this request. If they do say no, or if you do not have a treating physician to ask, Social Security will arrange an appointment with a doctor of their choosing. You are able to request a certain type of doctor to examine you, based on your condition, but the SSA may be unable to fulfill this request. 

What Happens During a CE?

During your CE, the doctor will complete a physical examination and ask you for a detailed medical history. They may also complete certain tests or exams that the SSA has requested based on your impairment. 

The report of your CE will include the findings of the physical exam, any additional testing the doctor performed, and your detailed medical history. The CE will not include treatment advice or whether or not the doctor feels you qualify for SSDI. 

How a Disability Attorney Can Help

If you are applying for SSDI benefits and you fear that you could be denied because of inconsistent medical treatment, you should consider hiring a disability attorney

An attorney can provide you with guidance with arranging your CE with Social Security and assist with gathering medical evidence. They are also able to advocate on your behalf and best explain the gaps in your medical treatment. 

Their legal services come at no cost to you unless your case is won. If they do win for you, they charge 25% of your back pay, or $6,000 -Whichever amount is lower. This $6,000 limit is federally mandated and will not change regardless how much you may win. 

Victory Disability is a nationwide law firm. We specialize in helping disabled workers get the benefits that they have earned and deserve. To see if we can assist you, take our free evaluation by clicking here