Lack of Medical Treatment in Social Security Disability Cases

By Pitt Dickey

In my practice I have frequently had clients come into the office who were not able to work due to serious illness coupled with severe pain but who were caught in the Catch 22 situation of not being able to afford regular medical care and medication because they were without medical insurance due to their being unemployed. If the claimant has not had regular medical treatment this can tend to an unwritten assumption by the system that his health problems may not be serious enough to warrant being awarded disability benefits. The equation seems to be "no medical treatment being the equivalent of no serious medical problem."

Unfortunately out in the real world where most disabled people live, no medical treatment generally means no money or insurance to pay for doctor and prescription bills. Disabled people would love to have access to regular professional care and the expensive diagnostic testing procedures such as MRIs and CAT Scans that the insured class takes for granted. For a fellow who has worked laying tile who suffers from chronic obstructive pulmonary disease as a result of the dust he has breathed on his job for the last twenty years, the ability to pay for an MRI when he can’t afford his rent can be unattainable as the moon. In the application process the disability claimant can certainly explain to the SSA representative why he hasn’t been getting regular medical treatment but I can’t help but think that the lack of such treatment impacts adversely on the claimant’s disability claim.

People without insurance or resources to pay for medical treatment and prescriptions frequently resort to the "self medication" solution. They begin to self medicate with huge doses of over the counter pain medications such as Tylenol. They self medicate with alcohol to numb their pain. A person in pain taking excessive doses of over the counter pain medication can end up becoming addicted and with new and even more complex health problems resulting from this overuse of over the counter medication.

Until 1996 the Social Security Administration could and did award Disability Insurance Benefits to claimants who had been medically determined to be addicted to drugs or alcohol. While this disability classification led to a fair amount of abuse and federal tax dollars going to support the drug and alcohol habits of drug addicts and alcoholics it also allowed people who had been self medicating to qualify for benefits and get medical treatment. Congress changed the law in 1996 to provide that an individual "shall not be considered to be disabled ... if alcoholism or drug addiction would . . . be a contributing factor material to the Commissioner’s determination that the individual was disabled."

If a claimant had an alcohol abuse problem and another health problem such as diabetes with end organ damage the claimant could still qualify for SSA disability payments based upon the diabetic problems. However the SSA looks much more closely at claimants who have a history of drug or alcohol abuse.

Where to go for Medical Help

So what is an unemployed worker with expensive medical needs to do to get medical treatment? Fayetteville is fortunate to have the Care Clinic located at 239 Robeson Street. The Care Clinic is staffed by volunteer physicians, pharmacists and other health care providers and serves those people who cannot afford medical treatment. The Cumberland County Health Department located at 1235 Ramsey Street, Fayetteville NC provides medical treatment at no or low cost depending on the circumstances of the ill person. The Health Department has a Medication Access Program (CCMAP) which assists patients in obtaining medications they cannot otherwise afford. The Cumberland County Mental Health Center located at 109 Bradford Avenue provides mental health counseling and treatment at no or low cost. In time of medical crisis both Highsmith Rainey Hospital and Cape Fear Valley Medical Center will provide treatment through their emergency rooms regardless of the person’s ability to pay.

Medical help is available for those who are unable to pay for it. You have to look for it and be willing to wait in line but it is available.

Pitt Dickey has practiced law handling Social Security disability cases in Fayetteville since 1978. . He practices with the firm of Smith, Dickey, Dempster, Carpenter, Harris & Jordan, P.A. at 315 Person Street and can be reached at 910 - 484-8195 or pitt@smithdickey.com or www.smithdickeydempster.com.