Raise your hand if you love having surgery. Didn’t think so. But if you are applying to the Social Security Administration (SSA) for Social Security Disability Insurance benefits (SSDI or “disability benefits”), refusing to have surgery could affect your disability claim status.
SURGERY, THE SSA AND YOU
While there are exceptions to every rule, in general, if you are applying to the SSA for disability benefits (or even for Supplemental Security Income (SSI)), and you have a physical impairment that could be improved by surgery, but you refuse to have the operation, you could be barred from receiving benefits.
How can they affect your disability claim status, you ask, when it’s your body and you have a right to choose whether or not to have surgery?
They can do it because the federal government does not have to pay you benefits if you do not follow recommended treatment. You are still free to decide whether or not to have surgery, of course. It’s just that you need to be aware of how your decision may affect whether or not you receive government disability benefits.
To be clear, there are certain requirements that the treatment (here, surgery) must be met before refusing to have it will affect you negatively. The treatment must be such that it could fix your impairment and allow you to return to work. It must be specific (not general advice like “lose weight; or stop smoking’), and your doctor must prescribe (order) it. If this is the situation, then your refusal to have the surgery may prevent you from receiving disability benefits.
DENIAL BASED ON A FAILURE TO FOLLOW PRESCRIBED TREATMENT
There are certain findings that the SSA must make before denying you benefits based on a “failure to follow prescribed treatment.” For more information on this, contact us. However, you should know that if you refuse to follow your doctor’s prescribed treatment (for surgery or anything else) it can negatively affect your SSDI application.
To deny you benefits because you have refused to have surgery, the SSA (disability officer or Administrative Law Judge) must first find that all of the following are true:
- Your impairment prevents you from doing any work.
- Your impairment has lasted, or is expected to last, at least 12 months.
- Your treating doctor has prescribed surgery to treat your condition.
- The surgery is expected to restore your ability to work.
- Your medical records document that you have been prescribed the surgery and have refused to have it.
If the ALJ or disability officer finds that all of the above factors exist and are true, you can be denied benefits for refusing to have surgery.
You have the final say over whether or not you choose to have surgery. You will also decide whether to file a disability claim, or not. But the SSA has the final say over whether or not you qualify for SSDI benefits.
CONTACT US ABOUT YOUR DISABILITY CLAIM STATUS
Making important decisions that affect your health and your finances is never easy to do. As experienced social security disability attorneys, we can give you the guidance and legal advice you need. We have helped many people get benefits and we can help you, too. We have offices throughout Missouri, Kansas, and Illinois. We have offices in Oklahoma City, Oklahoma, too. We offer free consultations and we do not get paid unless you win your case. Contact us today or call us at (618) 732-0146 to set up your free appointment.