One of the frequent dilemmas faced by people who have little-to-no income is that they also lack the resources to obtain appropriate medical care for their treatment. Even if they can afford a doctor’s visit or manage to see a doctor through a community-funded clinic, they may not be able to afford the therapy or medication that the doctor prescribes.
In other cases, people suffer from mental illnesses that make it very difficult for them to comply with their doctor’s recommendation. Schizophrenics, for example, often lack the insight to realize that they need to follow a medication routine closely — and they may also lack insurance.
These types of situations are, unfortunately, very common among Supplemental Security Income (SSI) applicants — although they can apply to Social Security Disability (SSD) claimants as well. This naturally presents a big problem for people stuck in this predicament. If they aren’t getting treatment, how can they prove that they’re disabled? If treatment could make their condition improve, are they really even disabled at all?
The Social Security Administration (SSA) does recognize the Catch-22 this creates for some applicants, so they have a specific policy to address the situation. In essence, claimants can assert the idea that there is “good cause” for the lack of medical care. Some examples of what SSA considers a good cause include:
- The treatment puts the claimant at a high risk of death or amputation (like an organ transplant or open-heart surgery).
- The treatment includes opioids and a risk of addiction.
- The claimant has tried similar treatment in the past with adverse results (like surgery that made the condition worse).
- The claimant has received different opinions from two different doctors that contradict each other about a given treatment.
- The cost of the treatment is more than the claimant can afford, and there are no free resources available.
- The claimant’s religion prevents the treatment.
- The claimant’s disorder is of such a nature that it is incapacitating and makes him or her unable to understand the consequences of not following the treatment plan.
There are other valid reasons that can be offered, as well. SSA will consider any reason offered on a case-by-case basis.
Don’t let the fact that you don’t have a doctor or can’t afford care keep you from filing a SSI claim. Find out more about your legal rights today.
