No Insurance, No Money, No Doctor

It seems like more and more I have clients that are not receiving adequate medical treatment despite their severe impairments that prevent them from working. The main reason for not receiving medical care is the dilemma of having no insurance and no extra cash to pay for doctors visits.

First, updated medical treatment is absolutely essential to every Social Security Disability case. If the clients problems are not documented in the medical records, it does not exist in the eyes of Social Security. No matter if the client's back is "messed up", if it is not documented, it will be ignored by the Administration.

Second, any attorney needs to be apprised of any programs offered by the local state agencies. This will include Medicaid, energy assistance, food stamps, etc.

Third, most metropolitan areas may have "free clinics." They are hard to get into and may require some proactivity on the part of your client. If you dig deep enough, the client may be surprised how much is offered in the general public.

Fourth, some hospital will offer some sort of indigent help on medical bills.

Finally, and the one that seems to make sense to clients, is that you are better off spending some cash now in hope for a favorable result down the road. For example, you have a family doctor that wants to charge you $50.00 for every visit. If the client's hearing is not for a year or so, they may spend over $1000 in medical bills with medication. If the client has a PIA of $880, then they may be better off spending the money now to ensure that there are updated medical records for the Judge to make a good decision on the case.

Unless there are extreme circumstances, I will not let a client off the hook just because they have no insurance and no money to see a doctor. Effective attorneys will know of resources that will help a client. It may take some time on the attorney part, but competent and zealous advocacy are part of the trade and the clients will thank you for it.

Unfavorable Decisions

In a recent conversation, I was asked by another attorney, "What do you do when you have a client that is denied at the hearing level by an ALJ?" First, I have to give some perspective to my practice as a Social Security Disability attorney. In our office, we take most (and I do mean most) valid cases. That is to say, they have a pending claim for disability and have received a medical denial. If we can think of a plausible theory for disability, we will take the case.

That said, there are occasions when we will represent a claimant that has very little chance of success but would like to have their "day in court." What can I say, I am a bleeding heart and we are surprised on occasion with a win.

Back to the question. If I feel that the ALJ's decision is inadequate in his/her application of the laws, rulings, and regulations, I will appeal the case to the Appeals Council everytime. However, if the only basis is that the Judge didn't see it my way, an appeal may not be warranted. As a practice policy, I will usually appeal a case to the Appeals Council on most unfavorable decisions. Like it or not, I can usually find an error in the Judge's application of the law. More and more, I am appealing on the issue of the ALJ limiting a claimant to "unskilled, low stress work". This limitation is inadequate and leaves too many inferrences on the part of the Vocational Expert at the hearing. We are getting a lot of these cases remanded from the Appeals Council. Believe it or not, we still have the same ALJ giving this type of hypothetical.