Medical evidence is a cornerstone in proving a Social Security disability claim. However, some individuals are sometimes not able to receive the necessary treatment due to various factors including lack of medical insurance or other economic barriers. Social Security Ruling 82-59 addresses the issue of failure to follow prescribed treatment. The ruling states in pertinent part:
An individual who would otherwise be found to be under a disability, but who fails without justifiable cause to follow treatment prescribed by a treating source which the Social Security Administration (SSA) determines can be expected to restore the individual’s ability to work, cannot be [sic] virtue of such “failure” be found to be under a disability. (SSR 82-59).
In order to establish that an individual has failed to follow prescribed treatment, it must be shown that treatment which is clearly expected to restore capacity to engage in substantial gainful activity has been prescribed by a treating source, and the evidence of record discloses that there has been refusal to follow prescribed treatment. The Social Security Administration must determine whether the prescribed treatment can be expected to restore the claimant’s ability to work. If it is not found that the prescribed treatment is expected to restore the claimant’s ability to work, then the SSA may not use the “failure” to follow prescribed treatment as the basis for denying a claim. Further, where the SSA makes the determination of “failure,” a determination must also be made as to whether or not failure to follow the prescribed treatment is justifiable. If a claimant is able to prove their inability to follow through with prescribed treatment is justifiable, then again, the SSA may not use the “failure” to follow prescribed treatment as the basis for denying a claim.
