TN 12 (07-08)

DI 27520.015 Previous Denial, Closed Period, or Termination Based on Failure to Follow Prescribed Treatment

A. Revision Warranted

Only reopen an adverse determination (denial, closed period, or cessation) due to failure to follow prescribed treatment if the determination was incorrect.

Examples of this situation include:

  • The treating source did not actually prescribe the treatment; or

  • The treatment could not have been expected to restore the claimant's capacity for Substantial Gainful Activity (SGA); or

  • Good cause for failure to follow prescribed treatment existed.

NOTE: After denying a case based on failure to follow prescribed treatment, the fact that the individual may later agree to follow such treatment cannot be the sole basis for revising the previous determination

See Details

  • DI 27505.001 - Conditions for Reopening a Final Determination or Decision

  • DI 23010.005 - Failure to Follow Prescribed Treatment - Policies

B. Revision Not Warranted

When DDS cannot warrant revision of the prior unfavorable determination, but the claimant has subsequently arranged to follow prescribed treatment, the onset date could be that date when the claimant first arranged to follow prescribed treatment. For entitlement to benefits, the case must meet the following requirements:

  • The impairment must meet the severity requirement;

  • The impairment must be expected to last 12 continuous months from the established onset date; and

  • The claimant must meet insured status and other non-disability requirements.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0427520015
DI 27520.015 - Previous Denial, Closed Period, or Termination Based on Failure to Follow Prescribed Treatment - 07/28/2008
Batch run: 01/27/2009
Rev:07/28/2008