The Social Security Administration (SSA) looks at a number of factors when the agency decides if someone meets their criteria for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits. One of these is whether or not the disabled applicant would be able to work if they receive proper treatment for their condition.
That poses a problem for a lot of people who are not following through on their doctors’ orders. For example, statistics indicate that somewhere between 40% and 60% of those with mental illness do not take their prescription medication on time, if at all. When SSA evaluates whether or not someone is disabled, a patient who is “noncompliant” with their prescribed treatment may be denied benefits if SSA thinks that adherence could make them functional and capable of working.
Sometimes, refusal of treatment is considered justifiable.
Despite this general rule, SSA does recognize that there are some valid reasons why someone might not adhere to treatment. Noncompliance can be justified if:
- The treatment is risky: If there’s a high chance of complications from a prescribed treatment (or a low success rate), SSA may consider refusal of treatment justifiable.
- The treatment was tried before: SSA will excuse noncompliance if the patient has tried a treatment in the past with no success.
- The side effects are severe: Sometimes, side-effects from a treatment are just as debilitating as the disorder being treated, in which case refusal makes sense.
- There are conflicting opinions: If a patient has more than one medical provider and one advocates for a procedure or drug and the other is against it, the patient generally has the right to decide whose opinion they trust the most.
- There are religious issues: SSA does acknowledge that certain deeply held religious convictions run contrary to medical advice, such as the refusal of surgery or blood transfusions. If the refusal is grounded in sincere belief, SSA may still approve benefits.
- There are logistical issues: If someone cannot afford treatment or cannot obtain treatment in their location, that’s an acceptable reason not to be compliant.
- There are mental health issues: Finally, SSA recognizes that mental health issues are unique in that they can make compliance with treatment very difficult.
If you or your loved one refused treatment or are generally noncompliant with medical recommendations for one of these reasons, your SSDI or SSI claim may still be approved. Legal guidance can help you frame your argument in terms SSA can understand.