Finally, another primary reason why your claim for Social Security disability benefits may be denied in Illinois is a failure on your part to follow your treating physician’s orders in regards to your disabling condition. However, the process of having your claim denied is not solely based on your failure to follow treatment; the Social Security Administration maintains a strict review process, detailed below–
When an Individual Can Be Denied Based on Failure to Follow Treatment
According to SSR 82-59, individuals who apply for disability benefits and have a disabling condition may be denied benefits when:
- The prescribed treatment is expected to restore their ability to work; and
- They fail to follow the prescribed treatment option.
However, language found in SSR 82-59 also reads that there is an exception to this rule in the event that there “is a justifiable cause for the failure to follow such treatment.”
Failure to Follow Treatment Is Not the First Thing Considered
The same source identified above explains that failure to follow treatment is not the first thing considered. First, the Social Security Administration will determine whether or not the condition:
- Precludes the individual from performing any substantial gainful activity;
- Has lasted or is expected to last for at least 12 months or result in death; and
- Treatment that is clearly expected to restore the applicant’s ability to perform substantial gainful activity has been prescribed.
Indeed, the Social Security Administration will not deny a claim based solely on the applicant’s failure to follow treatment alone; they must first determine whether or not the treatment is expected to restore the applicant’s ability to work. If the treatment is not expected to restore the applicant’s ability to work, then failure to follow the prescribed treatment is irrelevant. If the failure is relevant (because the prescribed treatment is expected to restore the ability to work), then the SSA will determine whether or not the applicant has good cause for the failure to follow the prescribed treatment.
SSA Requirement to Contact the Individual and Doctor
Finally, as published in a Congressional Response Report titled “Failure to Follow Prescribed Treatment”, before the Social Security Administration can deny a claim based on failure to follow a prescribed treatment, they are required to contact both the individual claimant and their treating physician to determine and ask questions about the nature of the treatment prescribed, the “probable course of the condition” both with and without treatment, and why the individual did not follow the prescribed treatment. If good cause for failure to follow treatment is documented, the agency cannot deny an individual’s claim based on failure to follow. While good cause varies on a case-by-case basis, some examples might include inability to afford the treatment, fear of surgery, or mental impairment that prevents the individual from being able to make a rational decision about the treatment or fully understand the treatment.
Finally, before the applicant’s claim is denied when failure to follow treatment is relevant, the Social Security Administration must contact the individual to notify them of this, and will delay making a decision for 30 days, during which the applicant is encouraged to undergo the prescribed treatment.
Working with an Illinois Social Security Disability Attorney
If you are disabled and are unable to work, receiving benefits from the Social Security Administration can have a very positive effect on your ability to provide for yourself. However, millions of claims are denied by the Social Security Administration every year, often times because of applicants’ failure to present hard medical evidence of their disability, prove that their medical condition will last for at least 12 months or result in death, or follow a physician’s prescribed treatment. Further, if an applicant’s claim has been denied in the past, it is common for the claim to be denied again as a result of the applicant’s failure to remedy the reason for the initial denial.
At the offices of Tuite Law, our experienced Illinois Social Security disability lawyer knows how important disability benefits are to you, and understands what the Social Security Administration is looking for. Rather than risk having your claim denied, we strongly recommend that you call our law office today for a free case review. We can provide you with legal counsel and support, help you to prepare your claim, and review your application before it’s submitted to the Social Security Administration. If your disability claim is denied, we can also represent you during an appeal.
Working with our law firm improves your chances of your claim for disability benefits being approved. To schedule your first appointment with our law firm, please call us today or send us a message at your convenience using the contact form on our website.