El Paso Compliance Attorney

When applying for Social Security Disability, one requirement is to prove you have a medical condition that qualifies as a disability. To prove the medical condition is likely to persist, you must show you have followed all recommended medical treatment, and that the condition is unlikely to improve. Proving you are in compliance with all of your doctor’s suggested treatment is a large part of showing you have a disability. If there is evidence that following a treatment plan would improve the medical condition, you are not likely to be considered permanently disabled. 

If you believe you are eligible for Social Security Disability payments based on a medical condition, you should speak with an attorney to learn about the requirements of the program. Jon Sipes, Attorney at Law, devotes his practice to helping those with medical conditions improve their lives by claiming Social Security Disability benefits. Jon Sipes has extensive experience representing clients in initial applications and after denials for Social Security Disability benefits. He understands the importance of proving a disability by showing compliance with all recommended medical treatments. 

What Are Social Security Benefits?

There are two forms of Social Security Disability benefits: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Eligibility for either program depends on the number of years an individual has worked and paid Social Security taxes. The SSDI program requires that an individual has worked and paid Social Security taxes for at least 10 years. 

The SSDI program does not apply to individuals that have never worked and paid Social Security taxes or have done so but for less than 10 years. Instead, those individuals may apply for the need-based SSI program available to those with disabilities, are elderly or are blind.

SSDI payments are based on the amount an individual pays into the system; therefore, SSDI payments are generally larger than SSI payments. Another difference between the two programs is healthcare: those approved for SSI are eligible for Medicaid immediately, while those who are approved for SSDI must wait two years to qualify for Medicare. 

Proving a Disability

Disability Requirements

To be eligible for Social Security Disability benefits, an individual must prove he or she suffers from a severe, long-term medical condition that is expected to last at least one year or result in death. In addition, the medical condition must prevent the individual from performing any substantial gainful activity. In 2020, the Social Security Administration recognizes substantial gainful activity as performing work that results in earnings of more than $1,260 per month. 

Denial for Failing to Follow Recommended Medical Treatment

If an individual can prove he or she suffers from a long-term medical condition that prevents employment, the Social Security Administration may still deny benefits if an applicant fails to follow a treatment plan that would restore the ability to perform full-time work. The treatment plan must be recommended by the individual’s treating physician and must address the specific medical condition. 

Proving Compliance with a Treatment Plan

Medical Records

Medical records are the most critical piece of evidence to document an ongoing disability. It is not enough to visit a doctor two or three times for a condition. Individuals must be able to show continued attempts to cure or treat a medical condition by regularly seeking medical treatment for it. One way to establish this is by keeping all medical appointments and/or going to medical appointments routinely. To develop a history of seeking medical treatment, it is helpful to keep all documents provided by the treating physician and take notes related to the medical concern and the outcome of each appointment.

In addition to establishing a medical history, it is also essential to take any follow-up steps recommended by the treating physician. These may include scheduling an appointment with a specialist or seeking care from other providers, such as physical therapists or chiropractors. 

Prescriptions

To prove compliance with a treatment plan, individuals must also fill and take all medications prescribed by the treating physician. If there is some reason to discontinue taking prescribed medication, such as an adverse reaction, it is essential to follow up with the prescribing physician. If that is the case, an individual should document the issues with the prescribed medication and discuss other treatment options with the prescribing physician. If another medication is prescribed, it is important to fill and take the substitute prescription.

Following Directions

Individuals should attempt to follow their treating physician’s instructions as closely as possible. For instance, if a medication should be taken with food to avoid a negative consequence, individuals should eat before taking the medicine. 

In other situations, following the doctor’s instructions can also relate to behaviors that directly impact the medical condition. For instance, if a doctor recommends that an individual stop using drugs or alcohol, the individual should comply and refrain from using drugs or alcohol. However, the doctor’s instructions must be specific. A general recommendation of eating a low-fat diet and exercising is likely not specific enough to disqualify an individual from benefits if not followed. 

Continue Going to Your Doctor

Eligibility for Social Security benefits requires that the disability be current and continue for at least one year. For this reason, individuals should keep all medical appointments to document the ongoing nature of the disability

Consult with a Social Security Disability Attorney

Obtaining Social Security Disability benefits can drastically improve the quality of life for those with a long term disability. However, the application process is technical and specific, and many applicants are initially denied benefits for reasons that are not always clear. Many times, denial is based on failing to comply with a recommended treatment plan by a treating physician. If you have been denied benefits and aren’t sure why, attorney Jon Sipes, can evaluate your case and appeal any denial by showing evidence of your compliance with a treatment plan. Contact Attorney Sipes today to discuss your needs.