What if you are disabled and unable to work?
You would file for Social Security Disability Income (SSDI) benefits. Sounds simple enough.
Now let us consider another – more complicated – question.
What if there was a treatment for your disability which would allow you to work, BUT you cannot afford that treatment?
Can your SSDI claim be denied based on the fact that, with treatment, you could work?
Consider this case:
A young man had a below-the-knee amputation over 15 years ago, and began using a prosthetic leg that same year. He used that same artificial limb for several years, before it began cracking and causing his stump to bleed when worn for more than 30 minutes at a time. The man is unable to get around on one leg. However, he cannot afford a new limb and there are no assistance programs available to him for reduced or free repair or replacement of the limb. Modifications to the device itself have been tried, but to no avail.
When filing for SSDI, the Administrative Law Judge (ALJ), the medical expert (ME), and even the prosthetic provider, testified that the man cannot ambulate properly with his current prosthetic leg, and that he needs a new one. Furthermore, all agree that with a new leg, the claimant would be able to get around easily and, therefore could secure a job.
The question is then, can the man’s SSDI claim be denied based on the fact that, with treatment (which he cannot afford), he could work?
No, according to Virginia Social Security lawyer Doug Landau. Landau’s opinion is based on rulings in two prior cases:
- “The medicine or treatment an indigent person cannot afford is no more a cure for his condition than if it had never been discovered.” [McKnight v. Sullivan, 927 F.2d 241 (6th Cir. 1990) which adopted the 5th Circuit rule in Lovelace v. Bowen, 813 F.2d 55 (5thCir. 1987)]
- A claimant may not be penalized for failing to seek treatment she cannot afford; “[i]t flies in the face of the patent purposes of the Social Security Act to deny benefits to someone because he is too poor to obtain medical treatment that may help him.” [Gordon v. Schweiker, 725 F.2d 231, 237 (4th Cir.1984). Lovejoy v. Heckler, 790 F.2d 1114, 1117 (4th Cir. 1986)]