There is a lot that goes into filing for disability and it seems there are always new rules for denying claims. I want to discuss a new ruling regarding following prescribed treatment. SSR 18-3p went into effect October 29, 2018 and will apply to any decision after that date. This ruling state that someone can be denied benefits if he or she fails to follow prescribed treatment without good cause and that treatment would be expected to restore his or her ability to work.
This logic is not completely new as rules have been in place, but there were not clear guidelines on enforcing those rules and how they were to be interpreted. There are conditions to this rule., This rule does not apply if the treatment would not make a difference on someone’s ability to work. If you would be disabled regardless, you cannot be denied for failing to follow a prescribed treatment.
You may ask “What exactly does that mean for people whose doctors recommend certain medications or surgeries for their conditions?” One point is that the ruling requires that the recommendation does come from the patient’s own physician. In the past, a one-time examiner may state, “if this client had back surgery they could return to work.” The person could then be denied based on the opinion of that one-time examiner. However, with the new ruling, the person’s treating physician must be the one to recommend a surgery or treatment. A person cannot be denied based on the opinion of a one-time examiner. Additionally, the new rule states that a person cannot be denied for failing to follow lifestyle modifications such as dieting, exercise, or smoking cessation. That is no longer a viable argument to deny benefits.
This Ruling cites 8 reasons that are considered to be “good cause” for failing to follow prescribed treatment. In these instances, Social Security will find that a person had a good reason for not following the doctor’s orders.
1) Religion-You must state the religion and show evidence of why the religion does not permit it.
2) Cost-No health insurance or funds to afford the treatment
3) Incapacity- If you have a learning disabled person and they cannot understand the consequences for failing to do what is recommended.
4)Medical disagreement-When you have multiple physicians who each make different recommendations.
5) Intense fear of surgery- A statement from your doctor is needed to confirm the anxiety or intense fear of surgery.
6) Prior history-If you previously had major surgery for the same impairment and the surgery was unsuccessful.
7) High risk of loss of life or limb
8) Risk of addiction to opioid meds-Due to opioid crisis, they cannot force someone to take prescription opioid medications.
9) Other. -case by case.
All of these rules canbe overwhelming and the process can be frustrating. If you or someone you know needs help with a disability claim please call us at 251-343-1111 or 1-800-332-1529 or look us up online at www.gardberglaw.com. Send us a message and we will be happy to review your claim and see if we can help you get the benefits you deserve. Call one of the experienced disability representatives at Gardberg & Kemmerly, P.C. today for a free consultation. Gardberg & Kemmerly specializes in helping the injured and disabled in Alabama, Mississippi, Florida and Louisiana.