How Failing to Seek or Comply With Your Doctor's Treatment Affects Your Disability Case

Updated October 2 ,2018

The Social Security Administration's decision to award you benefits often depends on the credibility of your statements. That is, to get benefits the agency must believe you when you say that you experience symptoms such as pain, memory loss, or exhaustion, or when you say that your condition makes it difficult for you to carry out basic work activities such as walking, sitting, lifting, seeing, hearing, or communicating.

One of the ways Social Security evaluates your credibility is by looking to see whether you have sought treatment for your condition. If you have not spoken with a doctor or other medical practitioner about your symptoms, Social Security will conclude that your condition is not as severe or limiting as you say it is.

Another way Social Security assesses the validity of your complaints is whether you have complied with the doctor's recommended treatment by following your doctor's advice, taking your medication, using assistive devices such as a cane or brace, and keeping medical appointments. If you have failed to follow your recommended treatment, the agency will conclude that your condition is not as severe or limiting as you say it is.

On the other hand, if you have a long and extensive record of seeing numerous doctors and trying many different treatment options, the agency will find it more believable that your condition is severe and disabling.

When Social Security Can Deny Benefits for Failing to Follow Prescribed Treatment

When you fail to follow prescribed treatment, take prescribed medication, or undergo recommended surgery, Social Security can deny you SSDI or SSI disability benefits if the prescribed treatment, medication, or surgery would be expected to restore you to being able to work full time (do "substantial gainful activity)". Social Security recently released a ruling stating that prescribed treatment does not include exercise, quitting smoking, or losing weight by dietary modifications, so you cannot be denied benefits for not following these recommendations from your doctor.

The ruling also clarified that you are only required to follow the treatment recommendations of your own doctor, or a specialist that you went to see who was not hired by Social Security. You aren't required to follow treatment recommendations from any doctor or examiner who works for Social Security or Disability Determination Services, such as a consultative examiner, a medical consultant, a medical expert, or your claims examiner.

Acceptable Reasons for Failing to Comply With Treatment

Social Security is not allowed to draw any conclusions about your failure to seek or comply with treatment without considering whether there are good reasons for it. Acceptable reasons include:

• You cannot afford the treatment (and you do not have insurance coverage or your coverage is insufficient, and you do not have access to free or low-cost medical services).
• The side effects of a medication are worse than the symptoms.
• You have been told by a doctor that there is no treatment that would be effective.
• You are able to get by without treatment by structuring your activities to minimize or avoid symptoms.
• The prescribed medical treatment is against your religion.
• The prescribed treatment is for opioid medication and you are worried about the risk of addiction.
• You are unable to understand the consequences of failure to prescribe treatment.

If Social Security discovers in your application that you have failed to seek or comply with treatment, someone from the agency should contact you to find out whether there are good reasons for that failure. Nonetheless, if there is any possibility that you may suffer from this credibility problem, be proactive about telling the agency why you have not done more to treat your condition.

Mental Illness and Failure to Follow Treatment Recommendations

It is fairly common for people with mental illnesses to fail to seek or comply with treatment. Indeed, failure to keep appointments or take prescribed medication may itself be a symptom of mental illness. Therefore, if you suffer from a mental illness, Social Security should not hold your failure to seek or comply with treatment against you. Federal courts have overturned denials of disability benefits on that basis, requiring Social Security to reevaluate a disability application that was rejected because the mentally ill applicant failed to seek or comply with treatment.

Not Having Surgery When Recommended

If your doctor has recommended that you have surgery and says that it could improve your medical condition enough to allow you to return to work, but you refuse, Social Security could deny you benefits. However, if you have a good reason for not wanting surgery, there are exceptions to this rule. For more information, see our article on getting disability despite refusing surgery.

Not Following Treatment or Therapy for Alcohol or Drug Addiction

If you are addicted to or dependent on drugs or alcohol, and you would not be disabled if you were to quit using alcohol or drugs, this is a different issue than failing to follow your doctor's orders to stop drinking or using drugs. In this case, you would be denied disability benefits because your drug or alcohol abuse is a material factor that contributes to your medical impairment. For more information, see our article on getting disability despite drug or alcohol abuse.

Provide Complete Information about Your Treatment

Because your record of seeking treatment affects your credibility, it is important to make sure that Social Security has the information it needs to get all of your medical records. If you do not list one or more of your treatment providers in your application, the agency may not get a complete picture of the lengths to which you have gone to diagnose and treat your conditions. Include not only medical doctors but also chiropractors, physical therapists, pain clinics, nurse practitioners, mental health counselors, social workers, and anyone else who has evaluated you or provided treatment.

You should also be sure to give the agency complete information about any alternative remedies you have used to treat your symptoms. For example, if you take over-the-counter medications, receive massage or acupuncture, or engage in therapeutic exercise or meditation to relieve your symptoms, be sure to include that information in your application.

Learn more about how Social Security assesses a disability applicant's credibility.