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
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.