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Failure to Follow Prescribed Treatment Risks Denial of Disability Benefits

Updated on May 7, 2013

Required Conditions To Receive Social Security Benefits

While there are a number of reasons why you can be denied Social Security disability benefits, one of the thorniest issues is a failure to follow prescribed treatment.

Social Security regulations requires four conditions to be met before ruling a person has failed to follow prescribed treatment.

  1. A disability or impairment prevents you from doing an “substantial gainful activity.”
  2. The impairment has lasted or will last 12 months, or can be expected to end in death.
  3. A treating doctor has prescribed treatment that is clearly expected to restore your ability to perform full-time work.
  4. You have refused to follow your treating doctor’s prescribed treatment.

The conditions may seem straightforward, but there are conflicts that can arise in the prescribed treatment and the reasons you refuse treatment that your lawyer can cite in an appeal to overturn a denial of benefits. In addition, the medical treatment must be prescribed and not be simply a doctor’s advice to change your lifestyle, such as losing weight or stop smoking.

Any excuse you use for refusal of treatment is going to be looked at very closely by Social Security and won’t be accepted without solid evidence and documentation to support your refusal.

Violation of Religious Belief

You can refuse prescribed medical treatment if it violates your religious beliefs, but you must state your religious affiliation and show evidence that you are a member of that church before Social Security can rule your refusal was justified. But not any church will do. You must also show evidence that your church’s teachings prohibit the medical treatment. The evidence can be from church literature or a statement from church authorities.

The prescribed treatment conflicts with the advice of another treating source

If you have more than one doctor, one may disagree with the treatment prescribed by the other doctor to treat your disability for work. They may differ on the risks of a prescribed surgery, or the effectiveness of certain drugs. As a patient, these are difficult decisions you face. Your decision shouldn’t be influenced by a potential loss of disability benefits, so your decision to refuse treatment from one of our doctors can be ruled justifiable. The opinion of a non-treating physician, such as a doctor brought in by Social Security at a hearing to offer an opinion on the effectiveness of a certain treatment cannot be used to countermand the advice of your own doctor.

A prescribed surgery is highly risky

If the level of surgical risk is beyond the ordinary and expected risk of any surgery, your refusal could be ruled justifiable. Organ transplants and heart surgery can fall into this category, and many experimental procedures are extremely risky. Refusal to accept surgery that requires amputation of an extremity can also be ruled justifiable.

You have an extreme fear of surgery

This is a tough sell to Social Security, but if your fear of surgery goes well beyond the normal fear everyone has of surgery, and mental health professionals can document your extreme fear, Social Security officials might accept it as an excuse.

Failure to follow treatment is a symptom of your mental health disease

This may sound like a Catch-22 excuse. Your doctor prescribes a treatment for your mental health disease, but your mental health disease stops you from taking the treatment. A person in this situation will need a persuasive opinion from a mental health provider to convince Social Security at a hearing.

You can’t afford the treatment

Many disability claimants face an inability to pay for medical treatment, but to convince Social Security that your claim should not be denied, you must also show that you’ve exhausted all other options, including free and subsidized clinics and public assistance programs.

Other reasons for refusing medical treatment may also be ruled as justifiable by Social Security, but there are many shades of gray for a hearing to consider. If your reason for refusing treatment is found to be unjustified, you must be informed of that decision ‘s impact on your disability benefits and given the opportunity to undergo the prescribed medical treatment after all or appeal the decision in a hearing.

More Questions?

For more information on Social Security Disability claims, contact The Law Office of Samuel K. Silverman


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