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Disability If You Refuse Surgery

Disability If You Refuse Surgery

As part of the treatment plan for your disability, your doctor may recommend that you undergo surgery to improve your condition. At this juncture, many applicants for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) may wonder if they will be denied benefits if they do not elect to have surgery. Generally speaking, refusal to have a recommended surgery can result in you being barred from disability benefits through the Social Security Administration (SSA).

The reason behind this is that while you have the freedom to choose not to have surgery, the federal government does not have to award you benefits if: 1) you have a qualifying disability under the rules of the SSDI and/or SSI programs; 2) the surgery could fix your disability and allow you to work again; 3) your doctor orders it; and 4) your medical records document that you were prescribed the surgery, and you refused to have it. If your situation meets the above criteria, and you do not fall into an exception category, SSA could deny you benefits on the grounds that you failed to follow prescribed treatment.

Keep in mind that the surgery must be ordered by your treating physician, so even though the doctors who work for SSA will decide whether the prescribed surgery would likely allow you to work again, an SSA doctor cannot order you to have the surgery. And the surgery will not be considered necessary if having it will not restore your ability to work full time.

In order to determine whether the surgery would make you capable of returning to work, the medical consultant at Disability Determination Services (DDS) or an Administrative Law Judge (ALJ), depending on which stage your application is in, needs to obtain the complete reason why you refused surgery, including why it was ordered, what the likely outcome of it would be, and what the effects of not having it are. He or she should contact your treating physician and determine whether there are alternative treatments available; if there are, and you choose to follow an alternative treatment plan, SSA cannot deny you benefits for failure to follow a prescribed treatment.

Some exceptions to the general rule exist. For example, you will not be denied benefits for refusal to have a prescribed surgery if doing so is against your religion, you cannot afford to have the surgery, your fear of surgery is so great that having it would do you more harm than good, another treating physician advises against the surgery, the surgery is for an amputation, or you have previously had major surgery to correct the problem, but it was unsuccessful, and a similar surgery has again been ordered.

This list of exceptions is not exhaustive, and SSA will review all scenarios on a case-by-case basis before making a determination on the reasonableness of your refusal to have surgery.