• Stephanie O. Joy, Esq.

What you DON'T do, can effect your Disability claim - Failure to Follow Prescribed Treatment

We are all told things we should do or not do by our doctors. Some we do, some we don't do. Please know: Some non-compliant acts or omissions can shoot a hole in our disability claim, however. The SSA tells us that they consider non-compliance evidence as follows (i.e. your doctor will often puts the non-compliance right in your medical records, so there is no escaping it): Assessment 1: We assess whether the prescribed treatment, if followed, would be expected to restore the individual’s ability to engage in substantial gainful activity (SGA)

Assessment 2: We assess whether the individual has good cause for not following the prescribed treatment https://www.ssa.gov/OP_Home/rulings/di/02/SSR2018-03-di-02.html #1 - make sure to discuss with your doctor the CHANCES that such prescribed treatment will actually improve your symptoms and ask him to notate those chances in the records. (That does NOT mean telling the doctor you are applying for SSD or SSI - we'll have another blog post on that soon. #2 - If you do not choose to follow the medical advice, be sure to explain to your doctor why. If you do explain to him, it is more likely to end up in his record so the SSA can take it as evidence of #2. Some more common reasons for not following medical advice: A. a particular medication has negative, overly negative, side effects in your own experience. The negativity should clearly outweigh the benefits of the medication - if it doesn't, that can be evidence that the condition to be alleviated by the medication is not all that troublesome. B. a surgery, like all surgeries, come with serious risks of additional injury, impairment, death


C. a surgery, as a mediocre success rate D. a therapy, such as physical therapy - the pain after the sessions was very high and/or after several sessions, no improvement. NOTE: The latter is not a very good reason, if the medical provider or therapist indicates, as they tend to do, that it is a process take time. However, if the pain is excruciating, and the session records and/or intervening doctors' appointment records indicate you have been complaining about the terrible pain following sessions that lasts many hours or into the next day(s), that may help explain why you needed to stop the therapy


E. lack of insurance AND lack of other funds to afford the prescribed medical treatment, Again, be sure to be clear to your doctor so your reason may better show up in the record. F. Quitting smoking for cutting down - very hard to do, I get that! But make sure you start an endeavor recommended by your doctor to cut down, be it a medication to help you or group therapy or support etc. Be sure to report expressly to your doctor how much you have cut back and how you are really trying.


G. For those with vascular insufficiencies in the legs or feet, and/or swelling, and a recommendation of compression stockings - such an easy thing to do, yet many men in particular blow it off. Don't. Get them and explain to your doctor that you are using them (and wear them to appointment of course), and if they cause serious discomfort, make sure to tell your doctor so that if you feel compelled to stop them, your reason is documented. Again, it is commons sense - is the discomfort (which does not sound too bad) so much that you'd rather the dangers of not using them? H. Not following through on a noted referral - if your insurance won't cover that provider, tell your doctor and ask for a different specialist. Not seeing a specialist is bad enough for all your impairments, but when the doctor specifically points you that way, not following through may be like telling the world - my impairment is not that bad. And impairments that are not that bad to the owner, are not bad enough for anyone else, including the SSA.

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