If you are applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits, it is important to seek a doctor’s care and follow his or her treatment recommendations.
This may include getting surgery to help fix your impairment. If you refuse to have a procedure performed, this may result in a disability claim denial. However, there are some exceptions that exist.
Our experienced Social Security Disability attorneys in Phoenix are ready to offer legal advice and guidance during the entire claims process. We are also well-versed in appealing denial notices. We have helped many people get the disability benefits they need. The initial consultation is free of charge.
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Disability Benefits and Refusing Surgery
Everyone has the right to refuse medical treatment. The Social Security Administration (SSA) cannot force you to have surgery. However, if a doctor has recommended surgery because it could improve your condition and your ability to work and you refuse, the SSA does not have to pay you disability benefits. In fact, they may use your refusal as a reason to deny your disability claim.
For instance, say your doctor recommends spine surgery because he or she reasonably believes it will successfully treat the pain and symptoms you experience with degenerative disk disease. You refuse to have the surgery and do not seek a second option. In this scenario, you will likely be barred from receiving disability benefits, even though you have every right to decide not to have surgery.
The general rule is that you must follow your doctor’s treatment recommendations. Otherwise, it can negatively affect your eligibility for disability. This treatment must be specific and aid in your recovery.
Denial for Failure to Follow Treatment
Several factors must apply before the SSA can deny your disability claim based on a failure to follow prescribed treatment. The SSA first and foremost must determine the following truths:
- Your impairment prevents you from working
- Your impairment has lasted or will last for at least one year
- Your doctor has recommended surgery to treat your condition
- The surgery is expected to restore your ability to return to work
- Your medical records show that surgery has been recommended and you have refused it
Any prescribed surgery must be issued by your treating doctor. Your eligibility for disability will not be affected if the recommendation came from an SSA physician or consultative examiner. However, the SSA does have the final word on whether or not you qualify for SSDI, SSI benefits or both.
Possible Exceptions for Being Non-Compliant
There are some exceptions for not following the prescribed treatment rule. Refusing surgery in these cases cannot be grounds for a disability claim denial. These exceptions include, but are not limited to:
Fear of Surgery
If your fear of surgery has been well documented by medical professionals, the SSA may accept this as a reasonable excuse. Your treating doctor must be familiar with how intense your fear is. You may have been diagnosed with tomophobia – the fear of surgical procedures. Your treating doctor must submit a written statement to the SSA detailing that having surgery would cause you more harm than good.
Against Your Religion
Your non-compliance may be excused if undergoing surgery is against your religious beliefs. The SSA will require proof from an official of your affiliation with the religious institution and that your religion’s views on surgery are well-documented.
Cannot Afford Surgery
Should you be unable to afford the surgery – perhaps because your medical insurance does not cover it – this may be a reasonable excuse. You will need to show the SSA that you do not have the financial means to pay for the surgery and that you have exhausted all low-cost or no-cost treatment options. This may include applying for Medicaid or seeking help from a public assistance program.
Conflicting Advice Given
Your treating doctor recommends surgery but you seek the opinion of another doctor who advises against the prescribed surgery. You will not be obligated to comply with a treatment recommendation if given conflicting advice. These differing treatments must be documented in your medical records.
Past Surgery Unsuccessful
Your non-compliance may be excused if you have already had surgery to fix your impairment but it was unsuccessful. This includes undergoing the same or a similar procedure for the same impairment.
High Degree of Risk
If the surgery is too risky, the SSA cannot deny you disability benefits for non-compliance. Procedures with a greater risk of complications include open-heart surgeries and organ or bone-marrow transplants.
Amputation is Required
Surgery that requires or may involve the amputation of an extremity, such as an arm, leg, foot or hand, is a reasonable excuse for not following the recommended treatment.
The SSA conducts detailed evaluations on a case-by-case basis to determine if a refusal of surgery is deemed an acceptable exception. There are certain disability listings that will require having surgery.
Learn More About Your Eligibility for Disability
At Dayes Law Firm, we understand the challenges involved in SSDI and SSI disability claims. If your eligibility for disability has been jeopardized, we are here to help. It costs nothing to reach out and talk to an attorney at our firm. The initial consultation is free, without any risk or obligation involved.
We accept cases on contingency, so there are no upfront fees. We do not get paid unless you get paid.
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