If you have filed for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits, you should always seek doctor’s care and follow the treatment recommendations they give you. In fact, failure to do so may result in a denied claim for benefits.
No – Social Security Cannot Force You to Have Surgery
One question that sometimes comes up is whether Social Security can make you have surgery. The short answer is, no, they cannot. However, if a doctor has recommended it, having it would restore your ability to work, and you have not made any attempts for a second opinion as to the necessity and likelihood of success, Social Security may use that as a reason to deny your case.
If you have a physical impairment that could be improved by undergoing surgery, a doctor has recommended that you are a candidate for the surgery, and you refuse the surgery without seeking a second opinion as to the necessity of the surgery, Social Security may deny your claim for benefits.
How the Denial Works
If Social Security denies your case based on failure to follow prescribed treatment, there are several factors that must apply. First, the surgery has to be recommended and prescribed by your treating physician – not one of Social Security’s physicians or consultative examiners.
Second, in order to deny your claim for failure to follow prescribed treatment, the surgery that has been prescribed must restore your ability to return to work. Whether the surgery would restore your ability to work is determined by the medical consultant at the initial and reconsideration stages of a disability application and the administrative law judge at the hearing stage of a disability application. In making its decision, Social Security should understand from you why you refuse to have the surgery – including whether you understand why the surgery has been prescribed, what the predicted outcome of the surgery is, and what effects exist by your refusal to have the surgery.
Additional Exceptions
Some exceptions to the general rule of following physician orders include: fear, religion, cost, conflicting advice, and prior unsuccessful surgeries. For example, if your fear of surgery is so intense that having the surgery would do more harm than good, your physician would need to submit a written statement that your fear of surgery is actually a contraindication to having surgery. Cost can also be an exception to the rule – if you can show that you are unable to afford the surgery and there are no possible low/no cost treatment options, Social Security should not deny the case based on your refusal.
Conclusion
In short, Social Security cannot force you to have surgery, but they do not have to pay benefits for an impairment that could be improved with the surgery you have been recommended, but are refusing.