Failure to Follow Prescribed Therapy

Massachusetts Attorneys Representing SSDI Applicants

While disability benefits are meant to help any individual who is experiencing a medical condition that prevents them from working, the Social Security Administration must be wary of the possibility of abuse. While most disability applicants are honest individuals facing mental or physical difficulties that prevent them from working, there are rare instances where applicants seek disability for a disorder that they simply refuse to treat. In such situations, the SSA can and will deny benefits if warranted. At Kantrovitz & Associates, P.C., our SSDI attorneys have helped countless Massachusetts disability applicants understand their obligation to pursue treatment.

Treatment Non-Compliance

In order to qualify for disability, an individual must have a medical condition that temporarily or permanently impacts their ability to work despite efforts to treat or resolve the problem. This is part of why disability applicants typically have to experience a medical condition for twelve months or more before applying for benefits. If you have a medical disorder that prevents you from working, but that could be treated with a regime prescribed by a doctor, your claim for disability benefits for “treatment noncompliance.” Essentially, the SSA determines that, if you wanted to work, you could, through proper treatment of your medical issue.

The Non-Compliance Test

Denial of benefits based on non-compliance is more complicated than a simple determination of whether treatment is available. If the SSA determines that an applicant is not following a treatment regime or taking proper medication, it must then consider four other factors before denying benefits.

First, the impairment that you fail to treat must prevent the applicant from participating in substantial gainful activity. Second, the impairment must be one that the applicant has experienced for at least twelve months, or can expect will ultimately end in death. Third, there is a treatment available to the applicant which could restore his or her ability to do work. Finally, the applicant must refuse to participate in the treatment (as opposed to being unable to access the treatment). It is important to note that “treatment” means more than simply eating better or exercising – it must be a medication or form of medical therapy that can be prescribed by a doctor.

Fighting Back Against Allegations of Non-Compliance

If the SSA finds that an applicant does not qualify for disability on the basis of the non-compliance test described above, he or she will have the opportunity to present a defense to non-compliance. These are very limited defenses, but if applicable, will allow a disability applicant to receive benefits. Examples include:

  • Inability to afford the treatment prescribed
  • The treatment goes against religious beliefs
  • The treatment is extraordinarily risky
  • The treatment involves amputation of an extremity
  • Your physicians have conflicting advice on the value of the treatment
  • You have a mental condition where inability to follow treatment is a symptom.

In each of these instances, an applicant will have to provide documentation to support the defense claim.

Lawyers Helping You Understand Disability Benefits Obligations in Massachusetts

If you are considering applying for disability benefits, but have decided not to receive treatment for your medical condition, it is important to understand the effect that this decision could have on your right to benefits. While the SSA understands that certain conditions may make treatment difficult, or even impossible, it is generally the obligation of the applicant to take full advantage of regimes or medications that may be available before applying for SSDI. At Kantrovitz & Associates, P.C, our disability benefits lawyers can explain your obligations, and possible defenses to treatment in Massachusetts. If you live in the Boston metro area or in nearby communities in Massachusetts, Rhode Island, or New Hampshire, contact our office for more information at (800) 367-0871 or online.