Blue Facade

Can Social Security make me have surgery?

As a general rule, if you are applying for Social Security disability benefits or appealing a Social Security denial, Social Security can penalize you for noncompliance with your doctor’s instructions about your medical treatment or care. That means Social Security may deny your disability claim if you do not follow your doctor’s instructions. 

However, there are exceptions!!!

Social Security cannot just use the non-compliance rule whenever it wants to. See Social Security Ruling SSR 82-59.

  1. First, the doctor actually has to prescribe the treatment. Not just merely discuss the option of treatment.
  2. 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.
  3. 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 you for it. However, Social Security requires that you consider all types of free or subsidized sources of treatment, such as clinics, charitable and public assistance agencies.

Here are other reasonable excuses (based on §404.1530. Need to follow prescribed treatment and SSR 82-59):

  • The specific medical treatment is contrary to the established teaching and tenets of your religion.
  • Cataract extraction for one eye is prescribed but the loss of visual efficiency in the other eye is severe and cannot be corrected through treatment.
  • Intense and unrelenting fear of surgery to the point that the treating source later states that the individual is no longer a candidate for the surgery.
  • Any duly licensed treating medical source who has treated the claimant or beneficiary advises against the treatment prescribed for the currently disabling condition.
  • 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.
  • The treatment recommended involves amputation of an extremity (e.g., amputation at or above the tarsal region).

Note: even Social Security accepts that this is not meant to be a complete list. There can be other reasons excusing “noncompliance with treatment.” 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.