Social Security Disability Decline Surgery
How Are My Social Security Disability Benefits Affected If I Decline Surgery?
When you apply for Social Security Disability benefits in Florida, you will be required to prove, among other things, that you are actually disabled.
The definition of a “disability” is a very specific matter when it comes to Social Security Disability (“SSD”) benefits awards. While you might consider yourself “disabled” and be very well aware of your personal limitations, the Social Security Administration (“SSA”) reviews Florida SSD applications under a very specific set of criteria.
To be disabled in the eyes of the SSA, your medical impairment must meet its definition of “disability”—and you must be able to prove it.
The Social Security Administration Will Review Your Surgical History
To apply for Social Security Disability benefits in Florida, you will be required to submit medical documentation proving your disability.
In particular, you will be required to provide any prescription for surgery or a surgical procedure recommended by your doctor, any documentation demonstrating that you had such surgery, and documentation regarding the outcome of the surgical treatment.
Did it work? How has the surgery affected your ability to earn income? Are you better or worse now?
These questions will be considered by the SSA in the review of your provided medical documentation.
But what happens if your doctor advises surgery—and you decline?
How does that affect the outcome of your Florida Social Security Disability benefits application?
Why Decline Surgery?
How Are My Social Security Disability Benefits Affected If I Decline Surgery? Some reasons may be physical, or emotional—and a great many may be financial.
Your reasons for opting out of a prescribed surgical procedure may not be so simple as to encompass only one of these bases, for that matter.
Sound, familiar, and logical reasons for avoiding surgery even when your doctor insists that it is the right next step in your treatment include:
- Lack of medical insurance;
- Fear of anticipated side effects;
- Prior unpleasant surgical experience;
- Religious objections;
- And more.
Your reasons are your own.
However, when applying for Social Security Disability benefits, you are agreeing to provide the information required by the SSA to make a determination of your eligibility.
It is the case that refusing a surgical procedure recommended by your doctor can negatively affect the odds that your SSD benefits application will be successful.
It will be necessary, therefore, if you do decline surgery, to provide your reasoning to the SSA for doing so.
Depending on what your reasons for declining surgery actually are, they may be among those considered “reasonable.” That is, your SSD benefits application may not be declined in this case.
Which reasons for declining surgery are considered reasonable for the purposes of Florida Social Security Disability benefits applications?
We will discuss these in detail below.
First, however, lets’ review some basic information regarding the SSD application and approval process.
Who Is Eligible for Social Security Disability Benefits in Florida?
Social Security Disability benefits are available to those Florida residents in Orlando, Maitland, and elsewhere who are “disabled” as defined by the SSA and unable to earn income for a prolonged or permanent period of time.
Work Credit Qualification
To qualify for Social Security Disability benefits, you must first have earned a sufficient number of “work credits” to be entitled to benefits.
This means that over your working life prior to becoming disabled, you paid enough in Social Security taxes to be “insured” as defined by the SSA.
For the purposes of SSD eligibility, a “work credit” is a unit of measurement indicating a certain amount of employment or self-employment income earned in a given year. Depending on the year, it may be a higher or lower amount of income.
In 2022, for example, you would earn 1 work credit for each $1,510 in wages or self-employment income earned.
You can earn a maximum of 4 work credits each year.
When you apply for SSD benefits, the number of work credits earned from the year in which you turned 22 through the year in which you became disabled will be tallied up. (Your 1-5 lowest earning years will be deducted, depending on your age when you become disabled.)
You generally must have 40 work credits, with 20 of them required to have been earned in the 10 years prior to the year in which your disability began.
In addition, as noted, you must be “disabled” to qualify for SSD benefits in Florida.
The SSA will consider your medical impairment disabling if:
- You cannot work because of your medical impairment;
- You cannot perform the work you did prior to impairment or shift to new forms of work because of your impairment;
- Your medical impairment has lasted 1 year or more, or is expected to—or is expected to result in death.
The condition must, in other words, be severe enough to bar you from performing basic work-related activity (think walking or running or sitting) for at least 1 year.
If it doesn’t, the impartment must be among those listed on the SSA’s severe medical conditions list (also known as the SSA Blue Book).
There are, additionally, “special situations” and allowances for applicants whose impairment includes blindness and other specific conditions.
The bottom line, however, is that the Social Security Administration will not simply take your word for it that you are disabled: they want to see some evidence.
How To Prove Your Disability to the SSA
In addition to providing the necessary documentation to prove your identity to the Social Security Administration, you will also need to provide documentation evidencing your disability.
In particular, you will need to submit a completed Adult Disability Report.
This is a standard form required in Social Security Disability benefits applications that requires that you specifically describe your medical condition(s), your work activity (including education and training), your job history, your ability to perform work-related tasks, and information regarding your medical treatment.
The Adult Disability Report will ask you to list:
- All medicines and prescriptions, as well as the reasons for their prescription;
- All medical treatment for all physical or mental conditions;
- The names and addresses of all medical professionals who have treated you;
- The tests performed by those doctors and other professionals, as well as dates of testing;
- The results of all medical tests performed,
- Hospital and emergency room visits, including details of overnight hospital stays;
- And more.
You will also be expected to provide further medical evidence in your possession, including medical records, doctors’ reports, and recent medical test results.
The treatment history provided must include detail regarding prescribed, performed—or declined—surgeries.
Reasonable Reasons for Declining Prescribed Surgery
If you declined a prescribed surgery for a “reasonable” reason, your Social Security Disability benefits application may not be rejected.
Reasonable reasons for declining or opting out of surgery include:
- Lack of health insurance or insufficient coverage;
- Lack of ability to pay out-of-pocket costs;
- The advised surgical procedure is high-risk or unusual;
- You’ve been given a conflicting second opinion by another doctor;
- You’ve been advised that the surgical treatment may be ineffective;
- You’ve already had a similar surgery that did not result in a positive change to your condition;
- The surgery requires amputation;
- You harbor religious objections to the type of or particular procedure.
- You fear surgery or have psychological impediments to surgery.
This is not an all-inclusive list. An experienced Florida Social Security Disability Attorney, if consulted, can provide further information regarding reasonable reasons for declining surgery.
A Social Security Lawyer can, further, provide a valuable voice of experience in this regard.
Orlando and Maitland attorneys who specialize in SSD benefits will be able to tell you how often, realistically, in the “real world” of actual applications, SSD benefits are awarded when surgery is declined for your particular reason.
What To Do If Your SSD Application Is Denied
The vast majority of SSD applications are denied by the SSA even when surgery is not declined.
If you filed your application without a Florida Disability Attorney assisting you, you should consider consulting one as soon as you receive an initial rejection of your SSD benefits application.
You have the right to request that the SSA reconsider your application, providing new information or documentation, or with the correction of errors that an experienced Disability Attorney might have avoided from the start.
Beyond that request, you have the further right to request a hearing before an Administrative Law Judge to argue your case with witness testimony proffered in support of your claim.
A Florida Disability Attorney will certainly be required to ensure that this hearing is conducted properly and to your advantage, should you elect to continue to argue your claim.
Florida Social Security Disability Attorney Shea Fugate will ensure that your odds of success are properly maximized, even where you have declined a prescribed surgical course of treatment. Your reasons may be reasonable to you—but you will benefit from expert help in convincing the Social Security Administration of it.