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Can taking medication eliminate my chances of winning SSDI?

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Q:

Can taking medication eliminate my chances of winning SSDI?

A:

Winning disability benefits can be difficult. In fact, it’s estimated that up to 65% of disability claimants are denied benefits the first time they apply. Denials are given for a variety of reasons. For example, many claimants are denied because they are working too much when they apply for benefits, or claimants do not have sufficient work credits to qualify for SSDI benefits. One of the main reasons claimants are denied, however, is because they are not getting appropriate medical care, or they are not following their doctor’s treatment plan.

SSDI and Winning Benefits

So what’s the best way to win your case? Go to the doctor at least every 90 days, follow your doctor’s treatment plan, and continue to take all medications as prescribed. This will help your claim because the SSA will make the assumption that you have received appropriate medical care and you have followed your doctor’s orders; but, despite all of your best efforts, you have continued to have a health condition that is so severe that you cannot perform substantial gainful activity (SGA).

What if I am not taking my medications?

What happens if you refuse to take your medications and do not follow your doctor’s treatment plan? Although there may be valid reasons for refusing to follow some orders (which we will discuss below), generally, if you do not take your medications, the SSA will make the assumption that your condition may not be severe or that if you took your medications, you may be healthy enough to work.

Although these assumptions may or may not be true, if you do not take your medications and follow your treatment plan, it will be difficult for you to prove that if you did do what the doctor prescribed you would remain disabled.

Can I refuse treatment?

The SSA does allow for claimants to refuse their treatment plan for what they describe as “good cause”. The following are listed by the SSA as valid reasons to refuse medications or treatment:

  • The prescribed treatment contradicts or is contrary to the person’s religious beliefs.
  • The individual is unable to afford the cost of treatment, although willing to accept treatment if it is offered for free.
  • The individual’s fear of surgery is so intense that it is a contraindication for surgery.
  • Major surgery has been performed in the past for the same impairment and was not successful (i.e. multiple back surgeries).
  • The treatment is extremely risky (i.e. open heart surgery).
  • The individual is mentally disabled and cannot understand the consequences of the request or failure to follow the request.
  • The treatment prescribed includes an amputation of a major body part.
  • Another treatment source contradicts the treatment plan.
  • Treatment involves cataract surgery and the other eye is already visually impaired.

What if my condition improves with medication?

Another interesting consideration is whether or not your condition improves with medication and whether this can jeopardize your right to SSDI benefits. This question arises most frequently with claimants who have mental disorders.

For example, it’s not unusual for claimants with schizophrenia, depression or bipolar to have the ability to function and possibly even work if their condition is closely monitored and they are getting proper medical treatment, including taking the recommended medications.

But unfortunately, many claimants can only afford the proper treatment for their depression if they receive SSI or SSDI benefits because they are also getting Medicaid or Medicare. If the medical benefits are eliminated, it’s likely that they may not be able to get the proper medication, gradually slipping back into depression or experiencing repeated episodes of decompensation.

So what are your options? If you are currently taking your medications, you have not applied for SSDI benefits, and you are able to perform substantial gainful activity, you will not be approved for benefits.

If, however, you are receiving benefits, currently taking your medications, and feel that you now have the ability to work, you could lose your benefits if you go back to work and make too much money for too many months. You could also lose your benefits if the SSA decides to perform a continuing disability review and decides that you are no longer disabled.

Continuing Disability – Review What Next?

So what do you do if have a continuing disability review scheduled and feel that losing your SSDI and medical benefits could lead to decompensation? You will need to prove to the SSA that your recovery is tenuous and you could experience a setback if you go back to work.

To prove this, you will need to have had depression for at least two years; have evidence of episodes of decompensation; prove that increased mental or physical demands could be highly disruptive to your mental health; and prove that you are only functioning well because you are currently living in a highly supportive environment.

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