Why Medical Compliance is Important?
In order to substantiate your Social Security Disability benefits application, it is ideal to provide solid medical documentation, issued by an approved treating source (licensed physician), whenever possible. Medical documentation is the best resource to establish your inability to maintain gainful employment and give cause for your application. If that documentation demonstrates an unwillingness or refusal to follow medical advice it could detrimentally effect the outcome of your case.
The Social Security Administration (SSA) interprets non-compliance in two important ways. First, if Social Security determines treatment could restore your ability to work, but you fail to comply, your claim can be denied. Second, non-compliance can be a negative reflection on your credibility.
Social Security Disability Application Can Be Denied Due to Non-Compliance
To first address Social Security’s right to deny a claim based on non-compliance; it is important to understand, the ability to prescribe treatment is the responsibility of a treating source, however SSA has the deciding opinion as to whether the treatment prescribed could restore your ability to work. Further, Social Security has the authority to determine if you did indeed fail to follow prescribed treatment and whether or not that failure was justified.
Therefore, if you decide to not seek medical treatment for your condition, or you choose to not follow the instructions of your physician, your case is weakened and Social Security may assess your condition is not severe enough to receive benefits.
In contrast, if you have a history of medical care and complying with your prescribed treatment, yet are still unable to maintain employment, Social Security is more likely to see your condition as disabling and more likely to award you accordingly.
Justified Non-Compliance
The good news is Social Security cannot deny your application for non-compliance if you have a justifiable reason for not following or seeking medical advice. What determines justifiable? Well, there is no list of guaranteed reasons; however, below is a list which the SSA has deemed acceptable and is found on the SSA.gov website. The list is not inclusive, but it provides a guideline.
- The specific medical treatment is contrary to the established teaching and tenets of the individual’s
- The individual isunable to afford prescribed treatment, which he or she is willing to accept, but for which free community resources are unavailable.
- An individual’sfear of surgery is so intense that it is a contraindication for surgery.
- Major surgerywas previously performed with unsuccessful results and additional major surgery is prescribed for the same impairment.
- Thetreatment because of its magnitude (e.g., open heart surgery), unusual nature (e.g., organ transplant), or for some other reason is very risky.
- The treatment involvesamputation of an extremity, or a major part of an extremity.
- An individual with asevere mental impairment is clearly unable to understand the consequences of failing to follow prescribed treatment.
- A treating source advises against the treatment prescribed for the currently disabling condition.
Your Credibility Is Important
Medical non-compliance can adversely affect your case, even if the treatment prescribed is not expected to restore your ability to work. Many times physicians will make general recommendations that are not intended to cure a patient but instead to reduce symptoms. For example, your doctor may ask you to lose weight, stop smoking or drinking, or change your diet. Though, Social Security cannot deny your application solely for not following your physician’s recommendations, your non-compliance can go against your credibility. An administrative law judge (ALJ) or case reviewer could infer your condition is not as severe as you have alleged since you are unwilling to follow all recommendations established by your physician.
It is vital for your application that you obtain treatment whenever possible and follow all prescribed and recommended instructions by your treating source. This will enable you to put forth the most complete and solid case possible. If there are obstacles, preventing you from following your treatment provider’s recommendations, it is best practice to discuss openly your concerns with your physician so you can develop a plan that will allow you to follow instructions and maintain your credibility.
You’ve got enough to worry about, let Viner Disability Law help you navigate the disability process. From the initial application process to the hearing to federal court, we do it all.
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