New Regulations Regarding Failure to Follow Prescribed Treatment

On October 29, 2018, Social Security passed new regulations regarding a claimant’s failure to follow prescribed treatment.  Social Security Ruling 18-3p went into effect on October 29 for all claims that are decided on or after that date.  Essentially, the new regulation allows the agency to determine whether prescribed treatment, if followed, would be expected to restore a person’s ability to be employed, and if so, to deny benefits on that basis.

Prescribed treatment includes medication, surgery, therapy, use of durable medical equipment, or use of assistive devices.  Prescribed treatment does not include lifestyle changes such as dieting, exercise or smoking cessation.

If you fail to follow prescribed treatment, you must have good case for doing so.  Examples of good cause that are listed include religion, cost, an inability to understand the consequences of failing to follow prescribed treatment, when there is a disagreement between medical providers as to whether the prescribed treatment should be followed, an intense fear of surgery, prior history of major surgery for the same impairment with unsuccessful results, a high risk of loss of life or limb, or risk of addiction to opioid medication.

If the Agency determines that an individual failed to follow prescribed treatment without good cause, a denial of benefits will be issued.  The most important thing to note from this change in the regulations is the importance of adherence to recommended treatment by providers.