I don't want surgery. Can I get Social Security disability benefits if I refuse to have surgery?

Hand Holding Up a Red X SignYou may have excellent reasons for refusing surgery. Ultimately, you get to choose your own healthcare. No one can force you to consent to surgery. However, there may be consequences to refusing surgery.

Social Security Disability Eligibility May Be One of Those Consequences

In some cases, the Social Security Administration may deny your benefit application if you refuse surgery that would have likely allowed you to return to work after treatment.

The official reason for denying your application may be "failure to follow prescribed treatment" if the Social Security Administration finds that:

  • You have a disabling condition. A disabling condition is defined as a medical condition that prevents you from working for at least 12 months or is expected to result in death.
  • Your treating physician prescribed surgery. The "failure to follow prescribed treatment" denial only applies if the doctor you typically see prescribed the treatment. The Social Security Administration should not deny surgery if another doctor, such as a medical consultant who performed a consultative exam on behalf of the Social Security Administration, recommended surgery.
  • The treating physician expects the surgery to allow you to return to work. Your doctor may have suggested surgery, but not all surgeries are expected to cure medical conditions. Instead, the surgery may have been recommended to help you manage pain, keep your condition from getting worse, or help you improve, but not to the extent that you would be able to work.
  • Your medical records include documentation of your treating physician's recommendation for surgery and that you refused surgery.

The examiner assigned to your case should review your medical records. Additionally, if the examiner has any questions about your ability to work after surgery, then the Social Security representative should speak with your treating physician.

Social Security Disability Eligibility Even If You Refuse Surgery

In some cases, you remain eligible for Social Security disability benefits even if you refuse surgery. For example, your Social Security disability application should be approved if you satisfy eligibility criteria and:

  • The Social Security Administration can't establish a failure to follow prescribed treatment according to the requirements described above.
  • You are so afraid of having surgery that your treating physician considers your fear a contraindication to surgery. It's normal to be nervous about surgery, but if your fear is so intense that your doctor feels surgery will do more harm than good, you may refuse surgery and still get Social Security disability benefits.
  • You suffer another mental health condition that prevents you from having surgery. These conditions may be considered on a case-by-case basis.
  • It would be against your religion to get the surgery. You will need to provide evidence that you are affiliated with a religious organization and documentation of the religion's official teachings as they relate to the surgery.
  • You can't afford the surgery. If you can't pay for surgery and can't find any affordable way to get the surgery, then you may be eligible for Social Security disability even if you don't get surgery.
  • You've received conflicting advice about surgery. If you have more than one treating physician and one of the doctors does not recommend the surgery, you may be able to refuse surgery and receive disability benefits.
  • The proposed surgery is a high-risk procedure. You may refuse the surgery if the potential harm associated with the surgery puts you at significant risk of further injury.
  • The proposed surgery is to amputate an extremity.
  • The proposed surgery is to fix cataracts in one eye, surgery carries a high risk of complications, and you already have significant vision loss in the other eye.

The Social Security Administration also has the right to approve your application if you deny surgery for other reasons, as it deems appropriate.

Protect Your Rights With the Help of an Experienced Social Security Disability Lawyer

Our metro-Boston Social Security disability lawyers want to help you stay in control of your life and get the disability benefits you deserve. Contact us today for a free, no-obligation consultation about your Social Security disability eligibility and how we may be able to help you get fair benefits.

 

John L. Keefe
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Founding Attorney, Massachusetts Social Security Disability Lawyer