The short answer, maybe. SSA has a duty to analyze and consider the reason(s) you have chosen not to pursue certain treatment avenues. On many levels, there is a huge distinction between one person’s well-thought, educated choice in consideration of one’s body autonomy and another person’s willful non-compliance with a medical provider’s suggestion or prescription for treatment. Let’s consider the differences using a Social Security Regulation as our backdrop:
SSR 82-59 stands for the proposition that an individual with a “disabling impairment” for which there is a recognized medical treatment must avail him/herself to such treatment “unless there is a justifiable cause for the failure to follow such treatment.”
The adjudicator or Administrative Law Judge must first determine whether “failure” to follow treatment is a relevant issue. Doing so requires that the SSA representative identify that a treating source prescribed treatment “which is clearly expected” to restore an individual’s ability to return to work and that the medical evidence demonstrates that the individual has refused this prescribed treatment. Interestingly, if the Administration believes that a particular treatment may restore a person’s ability to work, but no treating source has prescribed that treatment, SSA must allow the claim. This provision is often where the Administration fails to follow the SSR and it is incumbent upon the claimant (or claimant’s attorney) to argue this point.
Moreover, where it is determined that the treating source did prescribe treatment clearly expected to restore a claimant’s ability to return to work, the Administration must consider the reasons why the claimant did not “follow orders.” The individual must be given an opportunity to express his/her position. The treating physician may also be contacted, essentially, to corroborate the claimant’s statements.
The SSR highlights what it considers “justifiable cause” for failure to follow prescribed treatment. It should be noted that although there are 8 causes listed within the SSR, the list is not meant to be an exhaustive list of examples; rather, it is meant to illustrate the types and kinds of causes that would reasonably lead to a conclusion that the individual made a well-considered decision about his/her medical impairments.
If a disabled person is already in payment status (that is, has been found disabled and is receiving benefits), the Administration must, upon determination that failure to follow prescribed treatment may be an issue, contact the disabled person. “The individual will be afforded an opportunity to undergo the prescribed treatment or to show justifiable cause for doing so.”
If you have received a Notice from the Administration advising that a review has been conducted on your case and the Administration has determined you are failing to follow prescribed orders, consider contacting an attorney to ascertain whether the medical decisions you are making for yourself fall under the “justifiable cause” provisions of SSR 82-59.
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