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Surgery do I have to get it before I apply for SSDI?

When do I have to have surgery?

Recently on our disability forum we had an applicant ask, “Do I have to have surgery before I can apply for Social Security Disability Insurance (SSDI)? There are several issues which must be addressed before answering this question and they will be discussed below.

Will the surgery correct your disability?

Often before giving disability benefits to a claimant the Social Security Administration (SSA) will determine if you have gone to a medical professional and received proper treatment for your condition. If you have not, the SSA is likely to assume if you had received good medical care your condition would have improved and you would have been able to resume work.

So one of the questions the SSA may ask if you have not received surgery prior to applying is whether or not the surgery could correct your problem. For instance, if you have a serious back issue which is painful and limiting your mobility but you have not seen a doctor, you have not gotten x-rays or an MRI or if even if you have done all of these actions but you but have not gone to rehabilitation, had surgery or tried any other rehabilitative treatment the SSA may look at other claimants who have done everything necessary to treat their condition and if they have gotten better the SSA may determine you could too.

How long will your condition last with and without surgery?

Another issue the SSA will evaluate is whether or not your condition will last 12 continuous months with or without. If your condition with or without surgery will last less than the one year they will determine you do not have a long-term health condition and will deny your case. If your surgery plus recovery time will force you to miss 12 continuous months of work, however, you may still be eligible for Social Security Disability Insurance (SSDI) benefits.

What if I refuse surgery or other medical treatment?

Refusing surgery or proper medical treatment can be a reason the SSA denies your Social Security Disability Insurance (SSDI) case. There are, however, some types of refusals which are allowed by the SSA and are not used as a reason for denial.

First the SSA will determine who prescribed the surgery. The SSA will give higher weight to the opinion of your own treating doctor since they are more familiar with your SSDI case. If they do send you to a consultative examiner and the C.E. suggests surgery will correct the problem but your doctor does not, they are supposed to value the opinion of your own doctor more than the C.E., but ultimately the SSA will decide whether or not the prescribed surgery would restore your ability to work.

Why can I deny treatment?

  1. Religious reasons- If you deny treatment for religious reasons the SSA will expect proof that you are affiliated with a religious organization which has well documented teachings they are against surgery. Such proof can be provided by an official of your religious organization.

  2. Fear- An intense fear that surgery may do more harm than good can be a reason to refuse surgery. This fear may need to be documented through an independent examination by a psychiatrist.

  3. You cannot afford the surgery. You must have proof that you have researched all available options in your community and no one is willing to provide the surgery for free or at a reduced cost.

  4. Doctors do not agree on treatment- If you have gone to several doctors and there are conflicting ideas on treatment options this could be reason to deny surgery.

  5. Previous surgery has not worked. If you have a back condition, for instance, and you have already had multiple surgeries which have not worked you may be able to argue that an additional surgery would not improve your condition.

Bottom line

Winning benefits will require you to see a doctor and follow their treatment options. If you have a reason for not getting the surgery you must prove it is valid.
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