If I Refuse Surgery, Can I Be Denied Social Security Disability?

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.

When You Can Be Denied for Failure to Follow Treatment

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:

• Your impairment prevents you from doing any work and the impairment has lasted or is expected to last at least 12 months.
• Your treating doctor has prescribed surgery to treat your condition, and the surgery is expected to restore your ability to work.
• There is documentation (in your medical records) that you have been prescribed the surgery and you have refused it.

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:

• Get a full reason from you as to why you are refusing to have the surgery. This includes making sure you understand why the surgery was prescribed, the predicted outcome of the surgery, and the effects of refusing the surgery, and
• Speak with your treating physician to find out what you were told by your physician and other options you were given by that physician.

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.

Exceptions: When a Surgery Refusal Can't Cause a Denial

There are exceptions to the failure to follow prescribed treatment rule. These exceptions include the following.

• Fear. Your fear of surgery is so intense that having the surgery would cause you more harm than good. To prove this exception, your treating physician must have enough contact with you that he or she is familiar with the magnitude of your fear, and your physician must submit a written statement that your fear of surgery is a "contraindication" to having surgery. If your treating physician does not know you well enough to know whether the surgery would do you more harm than good, the SSA may want an independent examination by a psychiatrist. Simple fear of the risks of surgery or knowledge of another who had a similar surgery with poor outcome is not enough to meet this exception.
• Religion. The surgery is against your religion. In order to meet this exception, you will be asked to provide proof that you are affiliated with the church and that your religion's views on surgery is well documented (meaning it is ordinarily known to those who are familiar with the teachings of your religion). Such proof can be provided by an official of your religious organization.
• Affordability. You are unable to afford the surgery and there are no places in your local community to have the surgery done for free or low cost. To prove this exception, you must show that you do not have the financial means to afford surgery and you have looked into all possible low-cost or no cost treatment options.
• Conflicting advice. Another treating physician advises against the prescribed surgery.
• Previous unsuccessful surgery. You have already had major surgery for the impairment that was unsuccessful and the same or similar major surgery is prescribed for the same impairment.
• High risk. There is a high degree of risk associated with the surgery because of the extreme or unusual nature of the surgery. Examples of such surgeries include organ transplants or open heart surgery.
• Cataract surgery. The surgery is for cataracts in one eye, and carries a high risk of complications, when the other eye has severe loss of vision and cannot be corrected.
• Amputation. The surgery is for amputation of an extremity or a major part of an extremity.

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.

Which Disability Listings Require You to Have Surgery

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:

• Certain cancer listings, such as cancers treated by bone marrow or stem cell transplantation
• Reconstructive surgery of a major weight-bearing joint
• Heart transplant, and
• Liver transplant.

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.