A reader wrote in with this question: “Can I get SSD benefits without being under a doctor’s care? I am broke and have no money to see a doctor now that my insurance ran out.”
Like so many other legal issues, there’s not a simple yes or no answer to this question. The truth is, you’re unlikely to get disability without adequate paperwork from a doctor. The federal government needs to see clear evidence that proves your claim. However, there are ways to pursue disability benefits (and get medical evidence) even if you cannot afford a doctor’s care.
Key Takeaways: Can You Get Disability Without a Diagnosis?
- To qualify for Social Security disability benefits, you need to prove that you are disabled and that your health issues severely impact your ability to work.
- The SSA requires medical evidence to support your claim, typically provided by a doctor or other acceptable medical source.
- Lack of access to medical care due to financial constraints can make it harder to gather necessary evidence for your ssdi benefits claim.
- If you cannot afford treatment, the SSA cannot deny your claim solely on that basis, but you still need to prove your disability.
- Previous medical records can be helpful for your disability claim if they relate directly to the condition(s) listed on your claim.
- Consultative exams provided by the SSA may be less thorough than exams conducted by private doctors.
- An attorney experienced in disability claims can provide valuable assistance, potentially covering the costs of obtaining medical records and increasing your chances of success in your disability claim.
What Requirements Must I Satisfy for Disability Benefits?
The federal agency that oversees and grants disability payments is the Social Security Administration (SSA). The SSA requires that all disability applicants meet certain qualifications before awarding them benefits.
In order to qualify for disability benefits, the first requirement is you must have a medical condition that meets the SSA’s definition of disability. It can be a physical injury, illness, mental health issue, or several different medical problems combined.
More specifically, your health issues must significantly limit your ability to perform basic work-related activities. Some examples include lifting, sitting, remembering, and standing 40 hours per week for a minimum of 12 months.
The SSA requires paperwork proving your health issues make you unable to work for one year. That paperwork will require that a doctor (or other acceptable medical source, in some cases) verifies your claim. If you aren’t currently under a doctor’s care for your issue(s), this may make it harder to get benefits.
What If I Can’t Afford A Doctor’s Care? Can I Still Get Disability Benefits?
Being under a doctor’s care helps when you are filing for disability benefits because the SSA requires convincing medical evidence. Failing to provide the required paperwork, or failing to prove your case, can result in being denied benefits. However, there are a number of qualifying reasons to not seek treatment that the SSA will not reject your application for.
If you didn’t comply with a prescribed care regimen for a condition that could easily improve with proper treatment, your claim is likely to be rejected. However, if you can’t afford treatment, the SSA can’t deny you benefits based on that alone, as it’s considered a good reason to not follow prescribed treatment.
Even if the SSA can’t deny your claim based on lack of access to care alone, you will still need to prove that you have a disability that prevents you from work. This can be made much more challenging with lack of substantial medical evidence, but even if you cannot afford a doctor’s care, there are things you can do to improve your odds of filing a successful disability benefits claim.
Prior Doctor’s Care, But None Recently: Will It Qualify for Disability Benefits?
If you cannot currently afford to be under a doctor’s care but you have old medical records and proof of previous medical treatment, you can gather any older records you have to submit to the SSA. Whether or not those previous records will be helpful for your claim depends on your current medical condition(s) and what your prior medical records can confirm.
For example, if you are filing for disability now due to ovarian cancer but your existing medical records mention a broken bone, those documents likely won’t help with for your Social Security Disability benefits application. Why? Because the SSA only cares about medical records that apply strictly to the condition(s) listed on your claim.
In addition, the SSA relies on a team it calls “Disability Determination Services (DDS)” to determine who qualifies for benefits. While there are likely medical professionals on that team, DDS employees do not examine you themselves. They simply review the information you submit with your claim. So if you fail to submit any evidence (i.e., a doctor’s support), then they’ll likely deny you benefits.
Will a Consultative Exam Be Enough?
If you’re wondering how to get disability without a doctor, it’s possible, but it can be challenging depending on your diagnosis. Unless your condition is one on the Compassionate Allowances list that the SSA says clearly meets its definition of “disability,” the DDS team will ask you to undergo a consultative exam.
The SSA sets up this evaluation for you with a Social Security doctor or medical professional of their choosing. The good news is that these exams are free (the SSA pays for them).
The downside is that appointments can be short and may not be comprehensive. Someone who does not know you or your medical history will oversee your exam. They will look only for things as directed by the SSA. This means they are less likely to offer an exam as complete as one that you’d get under a private doctor’s care.
What’s the Difference Between Going to a Disability Doctor and a Regular Doctor?
When you visit a private care doctor, you’re able to develop a long-term relationship, run a series of tests, and perform extensive exams to determine the cause of your health issues, try different treatment options, and document the nature of your disability. This can go a long way when you’re trying to win benefits for disability, as thorough medical evidence is one of the most important pieces of proof you can provide to the Social Security Administration when applying for disability or appealing your disability case.
By comparison, the consultative examinations done by a disability doctor provided by the SSA will be much less thorough, and they’ll have much less time with you. If you do not have an obviously severe disability or a disability that automatically qualifies you for benefits, the consultative exams may be insufficient for receiving benefits.
Can an Attorney Help Me If I Can’t Afford a Doctor’s Care?
If you cannot afford a doctor’s care, then you may not be able to pay the fees some offices charge for complete records. If that’s the case, sometimes an attorney can pay those fees on your behalf. Some states require doctors to provide copies of medical records for free if an attorney requests them.
In addition purchasing your medical documents, an experienced attorney can help you understand the SSA’s policies and procedures. In fact, having an attorney file your claim can triple your chances of receiving benefits within six months.
Our attorneys work on contingency, so you pay nothing out of pocket for claim help. In fact, attorneys may only receive any payment for legal assistance after you win your case. If you don’t win, then you pay $0 to the attorney who helps you apply for disability.
Ready to see if you may qualify? Click the button below to sign up for a free, no-obligation phone call from a disability expert near you:
Can You Get Disability Without a Diagnosis? Frequently Asked Questions (FAQ)
1. Can I apply for disability benefits without seeing a doctor?
No, typically you cannot. To qualify for disability benefits, you usually need medical evidence to support your claim. This evidence often comes from doctors, specialists, or other medical professionals who can assess your condition and its impact on your ability to work. However, there are some exceptions, such as lack of financial means to visit a doctor or religious exemptions.
2. What role do doctors play in the disability application process?
Doctors play a crucial role in the disability application process. They assess your medical condition, provide diagnoses, and offer opinions on how your condition affects your ability to work. Their medical records and opinions carry significant weight in determining your eligibility for disability benefits.
3. Are there any exceptions to the requirement of seeing a doctor for disability benefits?
In certain cases, if you have sufficient medical evidence from other sources such as hospital records, clinics, or qualified healthcare professionals, you may still be eligible for disability benefits without having established care with a current doctor. In addition, financial hardship and other exemptions can allow you to seek benefits without having a current doctor. However, the decision ultimately rests with the disability adjudicators who evaluate your claim, and you may find it harder to prove disability without up-to-date medical records and a doctor to support them.
4. Can I use self-reported symptoms to support my disability claim?
While self-reported symptoms can provide valuable information about your condition, they may not be sufficient on their own to qualify for disability benefits. Medical documentation from healthcare professionals is typically required to validate your symptoms and their impact on your ability to work.
5. What should I do if I don’t have access to medical care or cannot afford to see a doctor?
If you lack access to medical care or cannot afford to see a doctor, there may be community health clinics or programs available that offer low-cost or free medical services. Additionally, some disability advocacy organizations may provide assistance or guidance on accessing healthcare resources.
6. Can I seek disability benefits based on mental health conditions without seeing a psychiatrist or psychologist?
While seeing a psychiatrist or psychologist for a mental health condition is highly recommended, in some cases, other healthcare professionals such as licensed clinical social workers or therapists may also provide documentation to support your disability claim. However, the specific requirements may vary depending on the regulations of the disability program in your area.
7. Is it possible to appeal a denial of disability benefits if I haven’t seen a doctor?
If your initial application for disability benefits is denied, you have the right to appeal the decision. During the appeal process, you may have the opportunity to provide additional evidence, including medical documentation, to support your claim. It’s crucial to consult with a disability attorney or advocate to understand your rights and options for appeal.
8. What steps should I take to strengthen my disability claim if I haven’t seen a doctor?
If you haven’t seen a doctor but still need to pursue disability benefits, it’s essential to gather as much relevant medical evidence as possible from other sources, such as hospitals, clinics, or healthcare professionals. Additionally, you may consider seeking assistance from a disability advocate or attorney who can help navigate the application process and gather supporting documentation on your behalf.
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Lisa Allen is a writer and editor who lives in suburban Kansas City. She holds MFAs in Creative Nonfiction and Poetry, both from the Solstice Low-Residency Program in Creative Writing at Pine Manor College. Prior to becoming a writer, Lisa worked as a paralegal, where she specialized in real estate in and around Chicago.
