What if I haven’t been taking my medications regularly? Does that affect the likelihood of being awarded benefits?
The realistic answer is: maybe. Social Security Ruling 82-59 outlines the circumstances under which a failure to follow prescribed medications would be accepted as “justifiable” and would not preclude a finding of disability.
Social Security finds a failure to follow prescribed treatment if these four conditions are met:
- The impairment at issue precludes any substantial, gainful activity,
- The impairment has lasted or is expected to last at least 12 months or is expected to result in death,
- Treatment is clearly expected to allow the individual to engage in substantial, gainful activity, and
- There is evidence in the medical record that there has been refusal to follow prescribed treatment.
If these four conditions are met, Social Security will look to see if that failure to follow prescribed treatment is “justifiable.” What constitutes a “justifiable” failure is not defined by Social Security. Rather, they give 8 examples of what would be acceptable under their rules:
- Acceptance of prescribed treatment would be contrary to the teachings and tenets of one’s religion.
- Cataract extraction for one eye is prescribed but the loss of visual efficiency in the other eye is severe and cannot be corrected through treatment.
- Intense and unrelenting fear of surgery.
- Inability to afford prescribed treatment where free community resources are unavailable.
- Medical treating source advises against the treatment prescribed for the disabling condition.
- The person is unable to work because of a condition for which major surgery was performed with unsuccessful results, and additional major surgery is prescribed for the same impairment.
- Treatment carries a high degree of risk.
- Treatment recommended involves amputation of an extremity.
What if I don’t meet any of these 8 examples?
Well, although the ruling does not list a circumstance pertaining directly to mental illness, federal courts have recognized a mentally ill person’s noncompliance with psychiatric medications can be, and usually is, the “result of [the] mental impairment [itself] and, therefore, neither willful nor without a justifiable excuse” See this Federal case. That court found that when the individual did not follow prescribed treatment, it was due to psychological and emotional difficulties that would deprive that person of the ability to continue treatment or take their medication.
If you have applied for Social Security or are thinking of applying and have problems following your treatment or taking your medications, you can complete the internet form on the left side of your screen or give us a call at 877-332-3252. We would be more than happy to answer your questions.
