Medical Necessity of Canes, Walkers, and Wheelchairs in Disability Cases

A topic that often turns very contentious in a disability hearing is the “medical necessity” of an assistive device (e.g., canes, walkers, wheelchairs, crutches, etc.). Often, claimants who have problems standing, walking, or balancing rely on assistive devices to get around. The problem is that many claimants decide to use the assistive device on their own, or their doctor only suggests that they get an assistive device. 

Rarely do doctors formally prescribe the assistive device. At a disability hearing with an Administrative Law Judge (ALJ), the need for an assistive device will always come up. In the past, all that was generally needed was a formal prescription in the medical record for the assistive device or treatment records that mentioned the need for the assistive device. Under the current rules, it is more complicated to convince an ALJ that an assistive device is necessary. ALJs now prefer to see the assistive device noted regularly throughout the claimant’s treatment records. In addition, getting a statement from the claimant’s doctor to address the “medical necessity,” also known as a letter of medical necessity, of the assistive device is key. 

To establish “medical necessity,” the doctor must address the reasons why the assistive device was prescribed or suggested. This requires citations to supporting MRIs, x-rays, etc., to establish the impairment that necessitates using the assistive device. Also, pointing out treatment notes that address the claimant’s inability to stand, walk or balance, strength deficits in the lower extremities, poor gait, etc. are necessary to establish “medical necessity” of the assistive device. Given the complexity of how to prove to an ALJ that an assistive device is necessary, a claimant needs to make sure that the need for an assistive device is well-documented in their medical records, including a formal prescription or something in writing indicating that the doctor suggested that the claimant use of an assistive device as well as a brief letter where the doctor addresses the “medical necessity” of the assistive device. 

The use of an assistive device can be the final piece needed to support a claimant’s disability contentions, so making sure the claimant’s doctor properly documents the need for the assistive device is something every claimant can do to strengthen their disability claim. If you have questions about how to properly document the “medical necessity” of an assistive device, please contact the Social Security disability attorneys at Henson Fuerst today by calling 919-781-1107 or submitting a free case evaluation form online.

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