HALLEX on failure to follow prescribed treatment

JOA · Joined: 13 May 2004 Posts: 1786

20 CFR 404.1530 and 416.930 direct that "[i]n order to get benefits, you must follow treatment prescribed by your physician if this treatment can restore your ability to work." There's a good cause exception, for which the regs give five examples. SSR 82-59 expands these five examples to eight. The ruling cautions, however, that "[t]he specific reasons listed above are not all-inclusive as acceptable justifications for refusing to accept prescribed treatment."

What's notable about this not-all-inclusive list is that it doesn't include an example related to mental impairment. There is just such an example buried in the back pages of HALLEX, in often-ignored Volume II, as part of what's called an "Appeals Council Interpretation." It's at II-5-3-1. The ACI identifies the issue as this

Guest · Posted: Fri Aug 29, 2008 01:54 pm Post subject:

Certainly there are paranoid schizophrenics with a highly orgainzed delusional systems. That's not far fetched. I assume you find it over the top to think that taking a pill would make such a person employable.

JOA · Joined: 13 May 2004 Posts: 1786

What I meant by the "over the top" comment was that I think the example is stronger that it needs to be. That is, I don't think delusions need to extend to poisoning in order to constitute good cause.

I could be wrong, of course, but I believe delusions about not needing medication are more common. On a very brief search, it seems there's mixed evidence on this for schizophrenics:

cookie · Joined: 11 Aug 2008 Posts: 8

The more difficult circumstance, and I am very open to suggestions on how to approach this, is when the claimant understands exactly what they are doing when they reject treatment, and do so because the treatment itself is so horrible and disabling in its own right. Often even the treating physicians say that they cannot fault the patients for refusing to take the medications - think "AIDS drugs." Even when it is clear now that suddenly beginning to follow traditional treatment will not reverse the claimant's condition and return them to work, I've had occasionally fruitless discussions with ALJs and attorney advisors who are semi-convinced that if the medications had been started years before (say, when the appeal was first filed) then the claimant may have been able to return to work.

And even a statement from the treating physician that work was not in the cards for the claimant since their alleged onset date is not always enough to avoid onset date amending-arm twisting.

Guest · Posted: Wed Sep 03, 2008 12:14 pm Post subject:

I have a case coming to hearing today where issue of non-compliance may come up. Individual has a seizure disorder and an organic brain dysfunction from past CVA so they often forget to take meds. Will be interssting to see how it plays out.