Last Update: 6/7/2021 (Transmittal II-5-12)
HA 02530.001 Good Cause for
Failure to Follow Prescribed Treatment
Renumbered from HALLEX section II-5-3-1
Appeals Council
Interpretation
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SUBJECT
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Good Cause for Failure to Follow Prescribed
Treatment
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ISSUE
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Can the existence of a psychiatric impairment
provide good cause for a claimant's failure to follow prescribed
treatment?
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DISCUSSION
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Note: The terms “good cause” as
used in Social
Security Ruling (SSR) 18-3p and “good reason” as
used in 20
CFR 404.1530(b) and 416.930(b) should be considered
synonymous.
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Social Security Administration Regulations
at 20 CFR 404.1530 and 416.930 and SSR 18-3p provide
that a claimant will be found not disabled if he or she fails, without good
cause, to follow prescribed treatment that can restore the ability
to work. The regulations provide that we will consider a claimant's
mental limitations, among other things, when determining if the
claimant has good cause for not following prescribed treatment.
While none of the examples provided in these sources mention or
address psychiatric related reasons, except for incapacity causing
the individual to be unable to understand the consequences of failing
to follow treatment, the examples provided are not all-inclusive.
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The existence of a psychiatric impairment
may provide good cause for a claimant's failure to follow prescribed
treatment. For example, we may be able to find good cause for failure
to follow prescribed treatment in a case where the evidence shows
that the claimant has paranoid schizophrenia with symptoms including
a highly organized delusional system that leads him or her to believe
that people are attempting to poison him or her and that medication
prescribed by a physician is part of the poisoning “plot.”
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INTERPRETATION
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If a claimant has a psychiatric impairment
and his or her refusal to follow prescribed treatment is based on
that impairment or that impairment and a combination of other impairments,
the Appeals Council may find that such impairment is good cause
for not following prescribed treatment.
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APPLICATION
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The Appeals Council will apply this interpretation
in all cases that come before it involving the same issue.
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EFFECTIVE DATE
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CROSS-REFERENCE
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20 CFR 404.1530 and 416.930.
HALLEX HA 01250.034.A.2.
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