How Not Complying With Treatment Affects Your Disability Case

The Social Security Administration (SSA) wants to see that you've tried most, if not all, available remedies for your medical impairment before you file for disability benefits. The agency awards benefits to people with impairments that prevent them from working despite medical treatment, so having a condition that's stubborn enough that you can't fix it medically—despite following your doctor's recommendations—strengthens your claim that the condition is preventing you from working.

When your doctors recommend a course of treatment that could help you feel better, and you don't follow their advice, the SSA doesn't know whether the treatment would have worked well enough for you to return to work. If you don't have a good reason why you didn't follow "doctor's orders," Social Security will deny your claim based on failure to follow prescribed treatment.

When Social Security Can Deny Benefits for Medical Noncompliance

If you don't comply with treatment, take prescribed medication, or undergo recommended surgery, Social Security can deny your application for disability benefits if the treatment, medication, or surgery would be expected to improve your symptoms to the point where you could work full-time.

Your doctor might ask you to make what the SSA refers to as "lifestyle changes" like dieting, exercise, and quitting smoking. Such recommendations aren't considered prescribed treatment, so you won't be denied benefits if your doctor tells you to stop eating meat and you don't. (Lifestyle changes can be especially difficult to make, so the agency won't penalize you if you don't follow through.)

You also don't have to follow the treatment recommendations of any doctors but your own. Any treatment suggested by a doctor or examiner who helps Social Security decide disability claims won't be considered when determining whether you've complied with medical treatment.

Good Reasons for Failing to Comply With Treatment

Social Security can't deny you benefits for noncompliance without considering whether you had a good reason for refusing treatment. Examples of good reasons include:

• you can't afford the treatment
• side effects of a prescribed medication are worse than your symptoms
• you have a debilitating fear of a recommended surgery
• your religion prohibits a prescribed treatment
• your doctors disagree about what the proper course of treatment should be
• you're unable to understand the consequences of noncompliance
• a previous major surgery was ineffective and the same surgery was prescribed again
• opioids were prescribed and you're worried about the addiction risk, and
• the proposed treatment has a high risk of amputation or death.

If the SSA denies your application for failure to follow treatment and you have a good reason, such as the ones listed above, let the agency know. Social Security will sometimes reach out to you if they have a question about potential noncompliance, but if you take the initiative, you'll have a better chance of having your application approved on reconsideration or at a hearing.

When Mental Illness Results in Noncompliance

Anxiety and depressive disorders are some of the most common conditions where failure to follow prescribed treatment is an issue. Being unable to keep appointments or remember to take prescribed medications is often a symptom of these disorders. (This is especially true for people with bipolar disorder during a manic episode.)

Social Security is generally more understanding of noncompliance for applicants with mental disorders, but only to a certain degree. Getting a medical source statement from your regular psychiatrist, psychologist, or counselor can help show the agency that your failure to follow prescribed treatment is a symptom of your disabling mental condition.

Provide Complete Information About Your Treatment

At each stage of the disability determination process, Social Security will ask you to provide information about which medical providers you've been seeing and when you've seen them. Some applicants list only the doctors who they think are important to their disability application and inadvertently leave out key sources who can establish that you comply with your recommended treatment.

Cast a wide net when telling the SSA about your medical history. Include not just medical doctors but also chiropractors, physical therapists, pain clinics, nurse practitioners, social workers, and anyone else who has evaluated you or provided treatment. You don't have to submit your dental records if you're applying for disability due to heart disease, but if you're on the fence about which providers to include, err on the side of giving more information, not less.

You should also give the agency information about any alternative remedies that help you treat your condition. Let the SSA know about any over-the-counter medications, massage therapy, acupuncture, exercise, or meditation that you use to relieve your symptoms.

_{Updated September 14, 2022}