How can you win a case if you don't have health insurance and can't get seen by a doctor?
This really has to be one of the worst problems that claimants who are filing for Social Security Disability and/or SSI disability benefits have to face.
The way the disability system is setup, a disability claims examiner or a disability judge will have difficulty approving a claim for ongoing benefits if a claimant or the claimant's representative cannot produce recent medical documentation.
How recent? This varies, per the adjudicator and often varies according to the types of impairments that a claimant presents with (i.e. the prognosis and outlook for some impairments is not likely to change).
Generally, though, the last dated records an adjudicator examines should probably not be older than 2 or 3 months. And, in actuality, if the "newest" evidence in the file is three months old, then a claimant will be required to go to a CE, or consultative medical exam, which will mainly be simply for the purpose of obtaining recent medical evidence.
However, this is a problem for a sizeable percentage of individuals who are pursuing Social Security Disability and SSI claims. And this statement excerpt expresses the frustration that disability applicants feel:
"My lawyer told me it wasn't worth it, they'd go by what the judge said. Her advice was now that I live in California to get new doctors who document every little symptom even better. Of course with no insurance and the only way to get into the ability to pay neuro clinics, that is proving to be nearly impossible so far."
How do you go to a doctor on a regular basis when you no longer have health insurance? In most cases, you can't. True, sometimes a physician that you have a treatment history with will continue to see you, but, more and more, doctors are turning away patients who have lost their insurance.
This leaves disability claimants in the position of having to go to emergency rooms (which often provide a deplorable level of care), health departments, and free clinics (which often are very limited in their resources).
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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