Even if Social Security Administration finds that you are disabled, they may deny a claim over evidence of failure to follow a medical provider’s prescribed treatment under SSR 18-3p. Typically, this evidence consists of medical records where your providers note “noncompliance.” However, this notation alone does not necessarily warrant a denial on your claim.
Social Security Administration must first assess whether the prescribed treatment would restore a claimant’s ability to return to work. Prescribed treatment means recommended surgery, prescribed medication, therapy, or use of assistive medical equipment such as a brace or orthopedic device which would allow you to return to work without special accommodations. However, it does not include mere lifestyle changes such as dieting, exercise, or smoking cessation. Further, the treatment plan must be prescribed by the claimant’s own medical provider, not a consultative examiner or independent medical expert at a hearing.
If the prescribed treatment would restore the individual’s ability to return to work and the evidence indicates the claimant is not adhering to the prescribed plan, the adjudicator must also determine whether there is good cause for not following the prescribed treatment. The burden of proof is now on the claimant, but is relatively easy to show good cause at a hearing. Acceptable reasons include an inability to afford the cost despite a willingness to follow; mental incapacity; intense fear of invasive surgery; high risk of death, loss of limb, or opioid addiction; prohibition by the established tenets of the individual’s religion; or when another one of the individual’s own medical sources has documented disagreement with the prescribed treatment plan. Unawareness of the treatment plan is not an acceptable reason to disregard a provider’s treatment plan.
If Social Security Administration denies a claim for failure to follow prescribed treatment, the basis for this decision must be explained in writing.
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