When a person receiving disability benefits fails to comply with the rules regarding treatment for drug addiction or alcoholism, there can be serious consequences.
This blog post breaks down the regulations under Section 404.470, which outlines the suspension, resumption, and termination of disability benefits for individuals who do not adhere to the required treatment programs.
- Suspension of Monthly Benefits: According to § 404.470(a), if an individual receiving disability benefits is found to be noncompliant with the treatment requirements for drug addiction or alcoholism, their monthly benefits will be suspended. This rule is applicable to individuals entitled to disability benefits, widow(er)’s benefits, and child’s benefits based on disability, effective from March 1, 1995.
Despite the suspension of benefits for the disabled wage earner, benefit payments to other persons entitled on the basis of the disabled wage earner’s entitlement to disability benefits will still be payable.
- Resumption of Monthly Benefits: If the individual can demonstrate and maintain compliance with appropriate treatment requirements, their benefits may be resumed under the following conditions:
a. After 2 consecutive months of compliance for the first determination of noncompliance. b. After 3 consecutive months of compliance for the second determination of noncompliance. c. After 6 consecutive months of compliance for the third and all subsequent determinations of noncompliance.
- Termination of Benefits: If the suspension of benefit payments due to noncompliance with treatment requirements lasts for 12 consecutive months, the benefits will be terminated, effective with the first month following the 12th month of suspension.
However, benefit payments to any other person who is entitled on the basis of the disabled wage earner’s entitlement to disability benefits will continue to be payable.
Example: John’s Case with Noncompliance and Disability Benefits
John is a 45-year-old man who has been receiving disability benefits due to a severe back injury that left him unable to work. Unfortunately, during his recovery, John developed an addiction to prescription painkillers. As a result, his drug addiction became a contributing factor material to the determination of his disability, as described in § 404.1535.
To maintain his disability benefits, John is required to attend a treatment program for his addiction. However, John fails to comply with the treatment requirements and skips several therapy sessions. Consequently, the Social Security Administration (SSA) determines that John is not in compliance with the treatment requirements for individuals with drug addiction or alcoholism.
- Suspension of Monthly Benefits: Upon this determination, the SSA notifies John in writing, and his disability benefits are suspended starting the following month. His wife, who receives widow(er)’s benefits, and his child, who receives child’s benefits based on John’s disability, continue to receive their payments.
- Resumption of Monthly Benefits: John realizes the impact of his noncompliance and decides to comply with the treatment requirements. After attending therapy sessions and demonstrating compliance for two consecutive months, the SSA resumes John’s disability benefits.
- Termination of Benefits (Hypothetical): If John had continued to be noncompliant with the treatment requirements for 12 consecutive months, his disability benefits would have been terminated. However, his wife and child would still receive their respective benefits based on John’s previous entitlement to disability benefits.
Conclusion: It is crucial for individuals receiving disability benefits to comply with the treatment requirements for drug addiction or alcoholism to avoid suspension or termination of their benefits. Understanding the regulations in Section 404.470 can help ensure that benefits are maintained for those who rely on them.
At Hugo Fierro & Michael Perez, we are a team of dedicated professionals with a comprehensive understanding of the complexities involved in Social Security disability claims. We take immense pride in leveraging our expertise to offer personalized guidance and support to our clients. Our proficient team excels at navigating the intricate nuances of each case, thereby ensuring that you receive invaluable insights and customized assistance tailored to your unique requirements.