How Will Failure to Follow Prescribed Treatment Affect an SSD Claim?

 Posted on November 18, 2022 in Social Security disability

If you are planning to apply for Social Security disability benefits, or if you are currently receiving benefits, it is important that you follow the course of treatment that has been prescribed by your doctor or other medical professionals. Failure to do so can result in a number of consequences, including the denial of a disability claim or the loss of your benefits.  If you have encountered any issues related to treatment for your condition, it is important to understand how Social Security will address these situations.

When Will Social Security Consider Whether Prescribed Treatment Has Been Followed?

Treatment plans for a disabled person are typically put together by a combination of their doctor, physical therapist, and other medical professionals. The goal of the treatment plan is to help them improve their condition to the point where they can either return to work or stabilize their condition. There are a variety of different types of treatments that a person may be required to undergo. These can include (but are not limited to): 

• Prescription medications
• Physical therapy
• Psychological counseling
• Surgery 

Generally, Social Security will only look at whether a person has failed to follow prescribed treatment if all of the following conditions exist:

• The person would otherwise qualify for disability benefits due to the presence of a medical or mental health condition that has prevented them from maintaining gainful employment.
• The treatment in question was prescribed by the person's own medical providers. Recommendations made by medical experts or others who examine a person during the process of a disability claim will not be considered.
• There is sufficient evidence showing that the person did not follow a doctor's recommendations or take the proper steps to address and improve their condition.

If Social Security determines that a person has not followed the treatment plan that was prescribed, it will then look at whether the prescribed treatment would have been likely to improve the person's condition to the point where they would be able to return to work and maintain gainful employment. Social Security will also look at whether the person had good cause for failing to follow prescribed treatment. Acceptable reasons for refusing treatment include:

• A person's religion forbids them from undergoing certain types of treatment.
• The person cannot afford the recommended treatment and is unable to maintain health insurance coverage or obtain services through free or affordable community resources.
• The person is incapacitated to the point where they do not understand how their refusal to follow a treatment plan will affect them.
• Multiple doctors or medical providers that a person has consulted with disagree about the appropriate treatment they should receive.
• A person has an intense fear of undergoing surgical procedures.
• The person had previously undergone treatment similar to what has been recommended, with unsuccessful results.
• The recommended treatment will place a person at a significant risk of dying or losing a limb.
• The person has been prescribed opioid medications and is concerned about the risks of addiction.

Contact Our Milwaukee Social Security Disability Claim Lawyer 

If you are seeking disability benefits, you will want to take the proper steps to make sure you will be eligible. While it is important to attend scheduled medical appointments, take prescribed medications, and follow treatment recommendations, there are some situations where you may be unable to do so. If you are concerned that questions about whether you followed prescribed treatment will affect your disability claim, Pearson Disability Law, LLC can help you address these issues correctly. Contact our Milwaukee County Social Security disability attorney at 414-240-4801 to set up a free consultation and learn how we can help you receive the benefits you need.

Sources:

https://www.ssa.gov/OP_Home/rulings/di/02/SSR2018-03-di-02.html

https://www.ssa.gov/OP_Home/cfr20/404/404-1530.htm