As a general rule, if you are applying for Social Security disability benefits or appealing a Social Security denial, Social Security will penalize you for noncompliance with your doctor’s instructions. That means Social Security may deny your disability claim if you do not do what your doctors tell you.
But there are exceptions!!! Social Security cannot just use the non-compliance rule whenever it wants to.
- First, the doctor actually has to prescribe the treatment. Not just merely discuss the option of treatment.
- The treatment must also be clearly expected to restore functioning to the point that you are no longer disabled. That means, that the treatment is expected to allow you to go back to full time work. If you would still be disabled in spite of the treatment, then non-compliance is not an issue.
- The evidence shows that you have refused to follow the treatment.
Even if Social Security can meet these three burdens, there are reasonable excuses which will prevent Social Security from penalizing you for not following doctor’s instructions.
What if I cannot afford the prescribed treatment or medications?
Inability to afford prescribed treatment is the most common “justifiable cause” in failing to follow prescribed treatment. If you cannot afford the medication or procedure, Social Security cannot penalize for it.
Here are some other reasonable excuses:
- Intense and unrelenting fear of surgery.
- The treatment carries a high degree of risk because of the enormity or unusual nature of the procedure (e.g., organ transplant, open heart surgery).
- You are presently unable to work because of a condition for which major surgery was performed with unsuccessful results, and additional major surgery is prescribed for the same impairment.
- Even personal or third party knowledge of persons who did not improve, or perhaps worsened, following surgery similar to that recommended. However, this by itself may not be enough.
- The treatment recommended involves amputation of an extremity (e.g., amputation at or above the tarsal region).
- Any duly licensed treating medical source who has treated you advises against the treatment prescribed.
- Even the inability to self medicate because of a mental or physical impairment may constitute good cause.
Social Security has the burden on the issue of noncompliance. You must receive a full opportunity to provide specific reasons for noncompliance before benefits can be denied on that basis.
photo credit: preciouskhyatt
