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Could Refusing Surgery Affect Eligibility for Social Security Disability Benefits?

doctor and patient discussing situationOne of the things Social Security Disability claims examiners want to know is whether you have taken steps to treat your injuries and potentially improve your condition. If they see that an applicant has received treatment, but it has not improved their ability to work, this person’s application may be more likely to be approved.

Surgery may be an option for some people with disabilities as it may help reduce pain, increase mobility or have other positive side effects. However, some people may not want to get surgery for various reasons and refuse the procedure.

While the decision about surgery is up to the person, it is important to note that refusing to get surgery may affect your eligibility for Social Security Disability benefits. The Social Security Administration may say you have not taken enough action to mitigate your disability.

Below, we discuss how a decision about surgery could impact an application for federal disability benefits. If you have questions about seeking disability benefits, give us a call today. The experienced Harrisburg-based Social Security Disability lawyers at our firm have helped many people with disabilities recover benefits.

General Rules on Medical Treatment and Your SSD Claim

While each case is different, applicants are generally expected to follow their doctors’ treatment recommendations. If you refuse treatment and this treatment is viewed as something that could aid in your recovery and benefit you, your refusal could hurt your eligibility.

When the SSA is Allowed to Deny Your Claim

It is important to note the SSA is only allowed to deny a claim for failing to follow recommended treatment if the following statements are true:

  • The doctor recommended surgery to treat your condition
  • The surgery recommendation is in your medical records along with your refusal to get surgery
  • The surgery recommendation was made by your treating doctor
  • Surgery is expected to allow you to regain your ability to go back to work

However, your claim cannot be denied if a surgery recommendation was made by an SSA doctor or consultative examiner.

Are There Exceptions When Refusing Surgery is Allowed?

There are some situations when refusing surgery cannot be used as a reason to deny a disability claim. However, your situation must fit one of these exceptions.

Well-Documented Fear About Surgery

You cannot suddenly claim you have a fear of getting surgery. You will need to prove your fear of surgery is well-documented. For example, your treating doctor should know about this fear and have written about it in your medical records – your doctor may have diagnosed you with tomophobia, which is fear of surgical procedures. Your doctor must also write a statement saying getting surgery would cause you harm that outweighs the potential benefit.

Surgery is Risky

Sometimes a surgical procedure is so risky the patient could die or suffer severe complications, such as:

  • Infection
  • Deep vein thrombosis
  • Pulmonary embolism
  • Excessive bleeding
  • Serious allergic reaction to anesthesia

Organ transplants, open-heart surgeries and bone marrow transplants can be very risky. Other examples of risky medical procedures include:

  • Brain surgery
  • Cancer removal procedures
  • Intestinal transplant

Fortunately, if the surgery that is recommended is too risky, the SSA cannot deny your application for not complying with your doctor’s recommended treatment.

You Received Conflicting Advice

If one doctor recommends surgery but another does not, you may not be obligated to comply with the first doctor’s recommendation to protect your application for disability benefits. However, you must have these differing opinions documented in your medical records.

Previous Surgeries Did Not Help

If you already had surgery to improve your medical condition and it was unsuccessful, refusing another surgical procedure may not affect your eligibility for benefits. This is especially true if you are refusing to get the same procedure a second time.

Your Religion Prohibits This Surgery

If you can provide proof of your affiliation with a religious institution and your religion’s views on the surgery that is being recommended, the SSA cannot deny your application for refusing surgery.

Inability to Pay for Surgery

Sometimes people cannot afford a surgery. For example, they may have insurance that will not cover the procedure, or the out-of-pocket costs are too much for the patient to bear. However, you must provide evidence that you cannot afford the surgery and that you have exhausted other treatment options that are within your budget. For example, they may want to see if you have applied for Medicaid or other public assistance.

Surgery Involves Amputation

Sometimes doctors recommend the amputation of a limb, like your arm, foot, leg or hand. However, the SSA cannot use your refusal of this type of surgery as a reason to deny your claim. That said, they will do a detailed investigation to determine if your situation fits this exception.

It is important to note if there is a low probability that a surgery will make you employable again, the risks likely outweigh the benefits. That means it may be unlikely your refusal of surgery will hurt your eligibility for benefits.

Call to Discuss Eligibility for Disability Benefits

Schmidt Kramer helps Social Security Disability applicants recover benefits at no upfront cost. If you have questions about your eligibility for benefits, or you have a claim that has already been denied, we may be able to help.

You can call and schedule a free legal consultation and there is no obligation to hire our firm after this meeting.

Give us a call today. No upfront fees or costs. Call (717) 727-2669.