Proving Disability Despite Prescribed Treatment for a Year or Longer

One of the most important considerations prior to undertaking an application for disability benefits is not only the issue of whether one is going to remain disabled from all forms of gainful employment for what is likely to be a year or longer, but also whether this is likely to remain the case “despite prescribed treatment” as the regulations require. Many of the individuals contacting our office having received a denial letter from the Social Security Administration (SSA) are asking that we appeal their denial to the next level even before they have undertaken the type of treatment the SSA is looking to see. In the state of New Hampshire, your Social Security Lawyer would be filing an appeal request for a hearing an Administrative Law Judge, while in Maine and Massachusetts the appeal would be for a request for reconsideration (which carries with it a very high denial rate, and is pretty much a rubber stamp denial of the initial denial). Understanding what the regulations require when it comes to providing a Social Security disability claim can help one avoid countless appeals down the road.

Prior to undertaking an application, a disability claimant should understand that if the initiation of treatment is likely to cause them to recover sufficient so as to be able to return to work within a year the likely decision they will be receiving from SSA will be a denial of their claim for benefits. For any medical condition one believes is severe and disabling, SSA is looking to see not only that there is treatment from a primary care physician but also from a specialist. For instance, if one is having low back problems, has treatment been ongoing for some time with a primary care physician but little in the way of medication or referrals for testing has taken place: this will prove to be a red flag to SSA that the condition remains under control and is not so severe as to cause the need for significant medication management or for that matter testing (such as CT scan and MRI) which might help get at the root cause of the condition. If in fact the condition is considered by the claimant to be severe and disabling such that it is keeping them from working, SSA would be expecting to see that referrals to specialists such as to a neurosurgeon, a pain management specialist or physical therapy is taking place after the PCP has undertaken their own efforts to uncover the nature of the condition with which they’re dealing through testing and to address management of the condition through medication management.

Many claimants make the mistake of putting the cart before the horse and bring their claim for disability benefits before exhausting available treatment options that might cause them to improve such that they could return to work (and well before they’ve remained out of work for an extended period of time). SSA, however, is looking to see that the individual applying for disability benefits has struggled to get better first before looking to SSA for a disability check: the regulations do call for them to prove that they have remained disabled “despite prescribed treatment.” We are advising potential clients on a rather regular basis, if not daily, that for any condition they believe is severe, they should be in treatment with medical specialists who will provide them with the best chance of recovery. The goal should be to recover from one’s condition so that Social Security disability benefits are not necessary in the first place, or, assuming such benefits do become necessary as one does end up remaining disabled for a year or longer, is not necessary forever.

A Social Security disability lawyer with years of experience is indispensable in this regard: they will be able to review your treatment and provide you with the legal advice you need to ensure that you have properly undertaken the treatment that would be expected of you. Thus, whether you are presented with having to appeal a denied disability claim or you are considering an application for the first time, contact the Law Offices of Russell J. Goldsmith for a review your individual circumstances at (800) 773-8622 to ensure you receive the advice, and potentially assistance, you and your family need.