Why A Claim May Be Denied: Failing to Follow Doctor’s Orders

One of the ways Social Security evaluates the credibility of an applicant’s complaints is to look at whether he or she has complied with their doctor’s recommended treatment.

Medical Compliance – what does that mean?  Here is what Social Security is looking for:

Are they following their doctor’s advice?  This includes diet, exercise, refraining from smoking (common with heart conditions, cancer or respiratory impairments), drug and alcohol use.

Are they taking their medications as prescribed?  This is really important where an applicant is asserting diabetes as the cause of their disability, but not taking their insulin as prescribed.

Are they using assistive devices such as a cane, walker, or brace as recommended?

Are they keeping their medical appointments?

Are they attending physical or occupational therapy as prescribed?

Are they refusing to have a surgery that the doctor says will improve their condition enough to return to work?

Acceptable Reasons for Failing to Comply With Treatment

If an applicant has failed to follow recommended treatment, Social Security will conclude that their condition(s) are not as severe or limiting as the applicant is claiming.  However, Social Security cannot draw this conclusion without first considering whether there are good reasons for noncompliance.

Acceptable Reasons for Medical Noncompliance:

  • The applicant cannot afford treatment
  • The applicant does not have insurance coverage, has insufficient coverage, and does not have access to free or low-cost medical providers
  • The side effects of medications prescribed are worse than the applicant’s symptoms
  • The applicant has been told by their doctor that there is no available treatment that would be effective
  • Medical treatment is against the applicant’s religion

Advice for Advocates

When filing an application where noncompliance may be an issue, be proactive and note the reason why in the remarks section of the application.  This will flag the issue and allow a representative from Social Security the opportunity to contact the applicant if they need further information.  This also helps bolster the applicant’s credibility and may prevent an outright denial due to noncompliance.