NONCOMPLIANCE WITH TREATMENT: SSA’S POLICY

THE SSA LOOKS FOR COMPLIANCE IN YOUR MEDICAL RECORDS 

Noncompliance with medical treatment can be a huge problem if you are trying to win disability benefits. The Social Security Administration (SSA) wants to review your medical records and see that you have follow orders and comply with treatment. If you fail to do what your doctor orders, take your medication, or have the surgery your doctor recommends, then the SSA can deny your disability claim.

The SSA awards disability benefits only when you have a severe medical condition that prevents you from working for at least one year or when your condition will result in death. If medical treatment improves your condition and you can go back to work, then the SSA will find you are not disabled. But, if you don’t treat your medical condition, then don’t expect the SSA to pay you benefits. The SSA expects you to pursue treatment that may help you condition.

The SSA also expects you to go to the doctor and follow treatment advice. When your records show that you skip appointments, refuse treatment, or fail to take medication, then the SSA may conclude your medical condition is not as serious as you claim. Likewise, if you aren’t following the treatment advice, then the SSA will think that if you did, perhaps you could return to work. Therefore, your only real option is to comply with medical treatment. If you do that and still aren’t able to work, then the SSA should award you disability benefits.

WHY NONCOMPLIANCE WITH MEDICAL TREATMENT CAN LEAD TO A DENIAL

Noncompliance with medical treatment is one of the most common reasons the SSA denies disability claims. When you apply for benefits, the agency reviews your entire medical history. This review focuses not only on your diagnosis but also on how you respond to treatment and whether you follow medical advice.

If you do not attend doctor visits or fail to follow treatment recommendations, then the SSA may question the severity of your condition. The agency often reasons that if your symptoms are severe, then you would actively seek medical care. Additionally, if you have a severe medical condition, then you would follow your treatment plan because it reduces your pain and symptoms.

When you refuse procedures, stop taking medication, or ignore therapy instructions, then you aren’t doing what is helpful for your symptoms. When the SSA believes treatment could restore your ability to work, it may deny your disability benefits. A common example of how this plays out occurs when a person receives a medical diagnosis, such as Rheumatoid Arthritis. Upon being told they have the disease, they immediately quit work and expect to get benefits.

But a diagnosis alone is not enough to prove disability. Instead, you must comply with treatment, try to improve your symptoms, and see if medications will help you keep working. When your efforts fail to improve your condition, then your doctor will usually state that you cannot work. That entire process is the medical evidence that wins your disability claim.

THE ROLE OF MEDICAL EVIDENCE IN YOUR SSD BENEFITS CASE

When filing for SSDI or SSI benefits, medical evidence is essential. A diagnosis alone is not enough. You must show how the condition affects your daily life and work capacity. This includes records from your treating physicians, physical therapists, and any medical experts you have seen. Detailed notes that describe your symptoms and your response to treatment will strengthen your claim. However, noncompliance with your treatment plan will impair your chances of winning benefits.

Imaging results play a key role in proving your condition. MRIs, for example, can reveal the source of back and neck pain. EMG nerve studies may also confirm nerve damage. If you have had surgery, then reports and progress notes should be part of your application. The SSA wants to see that you have pursued appropriate treatment and that your symptoms persist despite these efforts.

In addition to medical records, your doctor can complete an RFC form that outlines your physical limits. This form provides a detailed picture of how your condition impacts your ability to work. It outlines how long you can sit, stand, and walk, and how much weight you can lift. The SSA uses this information to evaluate whether you can perform any type of work despite your condition.

NONCOMPLIANCE REASONS THAT THE SSA WILL ACCEPT

Although noncompliance with medical treatment can harm a disability claim, the SSA does recognize that some situations prevent you from following treatment. They review these situations under Social Security regulation 19-3p, which allows them to accept certain reasons as valid.

For example, the SSA understands that some people cannot afford medical care or medication. Financial difficulty may make treatment impossible, even when you want to follow your treatment plan. In these cases, the SSA will consider the lack of treatment reasonable.

Serious side effects from medication may also justify stopping a treatment plan. If medication causes symptoms that are worse than the condition itself, continuing treatment may not be realistic. In other cases, a conflict with religious beliefs may also prevent you from following treatment from your doctor.

Medical conflicts between doctors can also create valid noncompliance issues. If your doctors do not agree on the correct course of treatment, then you may hesitate to proceed. That is reasonable. The SSA may also consider your situation if you cannot understand the consequences of treatment decisions due to a medical condition.

If the SSA questions whether you followed treatment, the agency may ask you to explain the situation. Providing a clear reason and your medical evidence can help prevent a denial and may strengthen your disability claim.

WOULD COMPLIANCE WITH PRESCRIBED TREATMENT RESTORE THE ABILITY TO WORK?

WHY FOLLOWING MEDICAL TREATMENT STRENGTHENS YOUR CLAIM

Compliance with medical treatment is one of the most important steps you can take when filing for disability benefits. Regular doctor visits and consistent treatment create a clear medical record that shows your disability.

When you actively seek treatment, the SSA can see you are doing everything possible to improve your health. If your symptoms continue despite proper care, then your records demonstrate your condition truly limits your ability to work. This evidence plays a powerful role in a successful disability claim.

On the other hand, missed appointments and gaps in treatment often raise questions during the five step review process. The SSA may interpret missed appointments or noncompliance with treatment as a sign that your symptoms are not severe. Maintaining consistent medical care helps avoid these issues and provides the evidence needed to support your case.

DOES THE SSA SEE ALTERNATIVE TREATMENT AS NONCOMPLIANCE?

If you have already tried traditional medical treatments, then the SSA has no issue with you trying alternative treatments. For example, many people use massage, acupuncture, and chiropractic adjustments to treat pain. Similarly, many people use natural herbs to treat depression and anxiety. Of course, the SSA isn’t going to deny your case for using alternative treatments. However, if you only use alternative treatment, then you should be aware that the SSA doesn’t accept medical opinions from alternative sources.

The SSA has a regulation that allows them to only give weight to the opinions from an acceptable medical source. The SSA is very clear in stating who qualifies as an acceptable medical source. First, they accept opinions from licensed physicians. They will accept records and opinions from a psychologist, optometrist, and podiatrist. All of these must have a state license.

They will also accept evidence from a speech-language therapist for speech or language issues only. Additionally, they will accept evidence from an audiologist for hearing loss, auditory processing disorders, and balance disorders. Finally, they will also accept evidence from an Advanced Practice Registered Nurse and Physician Assistant, for medical conditions within the scope of their practice. These must also have a state license.

Please note that massage therapist, life coach, shaman, herbal medicine expert, and homeopathic doctors are not on SSA’s list of acceptable medical sources. You can go to these practitioners, but any “evidence” they provide will not be accepted. For example, if you life coach writes a letter about your symptoms of depression, the SSA will not accept the opinion. That is why you must get and follow treatment from an acceptable medical source, like a doctor. If they offer an opinion, the SSA is supposed to accept it.

WE OFFER A FREE REVIEW OF YOUR SSD BENEFITS 

If you need help filing for SSD benefits, then call our law firm. We offer a free review of your case. When you call us explain your situation. At that point, we will look at the merits of your case. Next, we let you know if you have a chance to win SSD benefits. We do not charge you for our review of your case.

If you are having problems with noncompliance, then let us know. Perhaps we can offer you some advice that might help. We have won over $100 million in SSD benefits for our clients. Hire us to be your Social Security legal team. We help clients win benefits in many states. Find out how to apply for SSD benefits in your state:

• California SSDI and SSI benefits
• Colorado SSDI and SSI benefit information
• Idaho SSDI and SSI benefits
• Nevada SSDI and SSI benefits
• Utah SSDI and SSI benefits

Hire the best Social Security legal team with no money down. Also, there is no attorney fee unless we win your benefits. Contact us today. We know that not being able to work and running through your savings is hard. Therefore, we will due our best to win your benefits as quickly as possible.

CONTACT US FOR HELP WITH YOUR SSD BENEFITS

An SSD attorney can help you learn about filing for SSDI and SSI benefits. Working with an attorney will help you have a strong case. If you hire our SSD law firm, then we will make sure your application for benefits is complete.

Likewise, we will appeal any SSA denial. We will also help you collect your medical records. Also, we will prepare you to be a better witness at your hearing. At your hearing, we also question the experts. The judge may hire a medical expert and vocational expert (VE) to testify at the hearing.

Normally, the medical expert comes to the hearing to testify about your mental condition. You will need an attorney to question the medical expert or object to testimony from the expert. The judge can also call a VE. The VE’s testimony will be about the kind of jobs you might be able to do with your physical and mental conditions. Learn why a VE attends your hearing.

Filing an application for disability benefits can be a difficult process. Hiring a legal team with experience to help you win benefits. This will make the application process easier for you. It will also help you win at the hearing. If you think you need the assistance of a law firm, then let us help you.

HIRE OUR TEAM FOR OUR EXPERT LEGAL EXPERIENCE

Hiring an attorney to win your SSD benefits is a smart choice. Obviously, you should hire an attorney with many years of legal experience. Your chances triple when you hire a lawyer with the experience to handle your claim. If you follow their advice, then your chances of winning benefits are much higher. If you avoid noncompliance and follow your treatment plan, then your chances of winning improve too.

Learn about our firm on our About Us page. There you will find information about Andria Summers. She can help you choose your Medicare advantage plan. Also, she has over 20 years of experience with our law firm.

Dianna Cannon has over 30 years of experience helping clients win benefits. She has a license to practice law in multiple states, including Utah, Nevada and California. Brett Bunkall also has years of experience winning SSD benefits. We are experts at what we do. You can trust us to help you win your SSD benefits.

In the past 30 years, we have won over 20,000 SSD benefits for our clients. Also, we help our clients get Medicare benefits and Medicaid benefits.

If you need help to win your Social Security case, then contact us. Take advantage of our free review of your case. Go to the doctor and avoid noncompliance with treatment. Remember, when we win benefits it is for the rest of your life. Therefore, secure your financial future by hiring the right law firm and the best doctors to help you with your claim.