Will Refusing Surgery Affect Your Disability Claim?

surgeonsIf you apply for Social Security Disability benefits, the Social Security Administration (SSA) will want to see that you have been seeing a doctor consistently and following his or her prescribed treatment.

Part of your treatment may include undergoing surgery to help improve your condition. If you refuse to have the operation, your disability claim may be denied. However, there are certain exceptions.

At Sigman Janssen, our lawyers have been helping disability claimants obtain the benefits they need for over three decades. We are here to help applicants secure the benefits they need and we offer a free consultation to answer any questions you may have about the process. If you have a valid claim, we charge zero upfront fees to represent you.

Talk to a lawyer today. Ph: (920) 260-4528

Applying for Disability and Refusing Surgery

It is every person’s right to choose whether to have medical treatment. This includes the right to refuse a surgical operation. The SSA cannot force anyone to undergo surgery.

However, if your doctor has advised that you should have surgery because it may improve your medical condition and help you return to work and you refuse, the SSA is not obligated to pay you disability benefits. The SSA may use your refusal to follow treatment as justification to deny your disability claim.

For example, perhaps you suffer from a spinal disorder and your treating doctor has advised that you undergo a spinal fusion because he or she reasonably thinks it will help provide pain and symptom relief. You refuse to have the operation and do not get a second opinion. In this case, you may be denied benefits, although you were within your right to refuse the surgery.

Claim Denied for Not Following Treatment

Before the SSA can deny a disability claim based on failure to follow the prescribed treatment, several factors must be considered. The SSA must determine that the following is true:

  • Your condition does not allow you to work
  • Your condition has or will last for at least a year
  • Your doctor has advised surgery to improve your condition
  • The surgery is anticipated to help you return to work

Your medical records must also indicate that surgery has been recommended and you have refused it. Your disability claim will not be affected if the recommendation came from an SSA-approved doctor or consultative examiner and not your treating doctor. With that being said, the SSA does have the final say on whether you are approved for disability benefits.

When Non-Compliance Cannot Cause a Denial

There are certain exceptions when being non-compliant cannot be used as a reason to deny a disability claim. These exceptions include the following:

Fearful of Having Surgery

Your fear of surgery must be well documented by medical professionals for the SSA to make an exception. Your treating doctor must be well informed about how intense your fear of surgery is.

Otherwise, the SSA may ask that you get an independent exam by a psychiatrist to validate that your fear is real and that having surgery could likely cause more harm than good.

Against Religious Beliefs

If having surgery is against your religious beliefs, the SSA may excuse your refusal of surgery. You will need to provide proof of your religious affiliation and that your religion’s beliefs on having surgery are well-documented. This information can be provided by an official of your religious institution.

Cannot Pay for Surgery

Your inability to pay for the surgery may be seen as a reasonable exception. You will need to provide proof that you lack the financial means to afford surgery and that you have exhausted all efforts in looking for low-cost or no-cost treatment options. This could involve qualifying for Medicaid.

Conflicting Recommendations

If your doctor advised surgery for your condition but you got a second opinion from another doctor advising against surgery, the SSA may make an exception. You are not obligated to follow treatment if given conflicting recommendations. Your medical records must show these differing treatments.

Previous Surgery Failed

If you previously had surgery for your condition but it was not successful, refusing another surgical procedure may be seen as reasonable. This includes undergoing the same or similar operation to help relieve the same symptoms.

High-Risk Factor

Some surgeries are risker than others. The SSA cannot deny your disability claim if the surgery that has been recommended comes with a higher risk of complications due to the nature of the surgery. Open-heart surgeries, organ transplants and bone-marrow transplants are all examples of risky surgeries.

Surgery Involves Amputation

Any surgery that may involve amputation of one or more upper or lower extremities will likely be seen as a reasonable excuse for not following the prescribed treatment.

We Are Available 24/7 to Take Your Call

Making important decisions about your health is no easy task. This includes deciding whether to have surgery to help improve your condition and enable you to work. Our experienced Social Security Disability lawyers in Oshkosh are ready to offer guidance in a risk-free, zero-obligation consultation.

There are no upfront fees to hire our firm and no fees while we work on a case. We only get paid for our services if we are successful in helping you secure the benefits you need.

Call us at (920) 260-4528 to get started.