Last week, I wrote a post describing a case that will be denied because of my client’s poorly worded testimony. Today, I want to continue this theme and talk about a far more common basis for hearing denials – gaps in medical treatment or absence of medical treatment.
I save hearing decisions in the cases I try. Fortunately I usually choose decent cases and I don’t have too many unfavorables, but not every case turns out to be a winner. Interestingly, when looking at the unfavorables as a group, certain trends emerged. Perhaps the most common thread had to do with gaps and inconsistence in medical treatment.
Here is the actual wording from one such decision in a case involving a woman with depression and anxiety:
Although the claimant’s anxiety is severe, she has had no significant amount of mental health treatment. Even though she has been in the Atlanta area, she has had no psychiatric treatment. Had she obtained treatment, her anxiety would not be severe. Her husband is working, so there is no apparent reason she could not seek mental health treatment if she chooses to do so.
In this particular case, the medical record was not particularly strong and the claimant’s treating doctor was unwilling to provide us with a completed functional capacity form. I find it interesting that the judge would focus on what was not there, rather than what was there. Could there be legitimate reasons why an individual would not seek mental health treatment? Is it fair to assume that the husband’s insurance would cover psychological or psychiatric treatment, or that the deductibles would be affordable?
I think that the lesson to learn from cases like this relates to the need for every claimant to build a “paper trail” of medical treatment records. Judges expect you to see your doctor regularly and to seek specialized help when necessary. If you don’t have a lot of money,you need to explore all options – local emergency rooms, public hospitals, free clinics. I think that the days are over when a claimant can win a hearing with a medical record that is less than an inch thick.
I am certain that there are many deserving claimants out there who truly are disabled, but who will be denied because the medical record is sparse. This may not be fair, but this is how the system works.
I wish other blogs would post hearing decisions.All they would have to do is remove sensitive material.Please post more as time permit.
I agree with this, Although I was approved for my ssi part of my claim, My SSD part as my lawyer told me, Would have been denied, if I did not drop it. WHY? My large gaps going to the doctor for a 18 month pd. He told me I ran the the risk of a unfavorable decision. I end up losing a lot of money. So now I am collecting just SSI;I ended up 3 years of back SSI payments. vs 4 1/2 years of SSd/ssi payments
If you get anything from my post,
GO TO YOUR DOCTOR! ALL THE TIME.
how long does it take for a desicion from appeal counsil from fall church virigina
I fully understand this womans need not to seek medical attention. I have been on disability since 1996, I have progressivly gotten worse with panic and phobia’s along with my medical conditions. I have not left my house for four months at a time (agoraphobia) I have unreasonable fears of everyting from food, germs, people, and esp doctors. I see my family physcian for everything once maybe twice a year if I am heavily medicated. Even so, since I am the only one with ssd, no one to really help me I am in a virtual panic after reading the above. I had a CDR Nov 2007, Sept 2008 they want another for lack of medical records. I have no idea if the ekg, eeg, bloodwork and seeing my doc a couple months ago is going to be enough. This is a fear already causing me insomnia, bouts of crying I cannot control…yet I can’t… just can’t leave my house. I don’t think it is lack of wanting treatment, it was lack of actual being able to go out in public and get it.
I see my doctors as often as they will let me. Getting free services from the county, I find that I am diagnosed with a condition, and then scheduled to see a specialist. The appointment is usually 6 months later.
They are so far into the future, and some of my meds leave me in such a fog, that if they didn’t send/call a reminder of the appointment, I wouldn’t make it as I have lost track of time.
I just had a hearing before a judge yesterday. He stated that would leave the case open because he needs to see medical records from 11/08 to 4/09, but, my psych DR wrote a letter dated 4/13th. am i still denied?
I think a lot of what you you say on those blogs are BS..one thing your audience dont know is..you need more than just strong work history,strong RFC and current medical treatment..your lawyer’s involement in the case is everything!also knowing the Judge is important! please spend some time with your clients!hopefully before Hearing..I had a very strong case and we blew it not preparing for Hearing..I should win on appeal, hopefully my lawyer will spend a few hours conversing with me…
“Is it fair to assume that the husband’s insurance would cover psychological or psychiatric treatment, or that the deductibles would be affordable?”
Yes, the judge’s assumption was reasonable in this case. It is the law that health insurance must cover mental illness to the same extent that it does physical illness. I believe that is part of HIPAA, but am not 100% sure about that. NAMI (National Alliance on Mental Illness) was one of the big movers & shakers behind that and would be able to tell you more.