Updated October 2, 2018
If you have a physical impairment that could be improved by surgery but you refuse to have the operation, you may be barred from receiving Social Security Disability benefits (both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)), based on that refusal. Although it's every individual’s right to choose what health care procedure they have performed, the government doesn't have to pay you benefits if you don't get surgery that could improve your impairment. Of course, there are some exceptions.
If having surgery could fix your impairment and allow you to return to work, and your doctor has recommended it, your refusal to have the surgery may prevent you from receiving disability benefits. For the Social Security Administration (SSA) to be able to deny you benefits based on "failure to follow prescribed treatment," the following must be true:
Who prescribed the surgery? It's important to note that the surgery must be prescribed by your treating physician. This means that the Social Security Administration (SSA) cannot have one of their physicians or consultative examiners, who have not provided you with treatment, prescribe a surgery that your treating physicians have not. The medical consultants (doctors) who work for Social Security, however, will have the final decision as to whether or not the prescribed surgery would restore your ability to work.
Will surgery restore your ability to work? If the surgery isn't expected to allow you to work full time after your recovery, you don't have to have it to receive benefits. It is up to the medical consultant at Disability Determination Services (at the initial application stage) or the administrative law judge (at the hearing stage) to decide whether surgery would restore your ability to work. Before Social Security makes this final decision, the agency should:
If you are following alternative treatment recommendations of your physician, rather than having the surgery, you can't be denied benefits for failing to follow prescribed treatment.
Before an applicant is denied benefits based on failure to follow prescribed treatment, the SSA will explain to the applicant that he or she must have the surgery in order to qualify for disability benefits, unless an exception exists.
There are exceptions to the failure to follow prescribed treatment rule. These exceptions include the following.
The SSA may accept other reasonable excuses on a case-by-case basis. The SSA will make a full evaluation in every case to determine if your reason for not having the surgery is an acceptable exception.
One way in which you can be approved for disability benefits is by meeting the requirements of a disability listing from the Social Security “Blue Book,” which is a list of impairments that are so severe that you will automatically be approved for benefits if you have all of the requirements found in that listing.
Those who refuse to have surgery won't be able to meet certain listings. Some of those listings include:
However, you may still be eligible for disability benefits even if you cannot meet a listing due to refusing surgery. The other ways in which you can qualify for benefits is by equaling a listing or proving you are unable to do any work.