Long-Term Disability Claim Denial
Substance use affects every social, economic, and demographic group. According to the Substance Abuse and Mental Health Services Administration, approximately 19.7 million people (aged 12 and above) struggle with some form of substance use, including addictions to alcohol, opioids, prescription medications, and illicit drugs.
When substance abuse limits or eliminates your ability to work, many professionals turn to their short-term disability and long-term disability policies for help. However, these people often find themselves battling their insurance company rather than focusing on their recovery. In this article, Bryant Legal Group’s disability professionals explain how you can get the help you need.
The Science of Addiction
Some people still believe addiction stems from a lack of willpower. However, scientists now understand that drugs can change how your brain functions. Most addictive substances affect your reward system, which is the instinctual part of your brain that helps you find and seek food, drink, and other sources of please and satisfaction. When you smell a barbecue and your mouth starts to water, your reward system has kicked in.
Addictive substances flood parts of your brain with dopamine, a chemical that gives us a feeling of euphoria. Over time, your brain will rewire itself to demand this feeling, which it now associates with the substance. Addiction can essentially reconfigure your mind to prioritize substance use over your work, family, and health and wellness. This process can change the way you think, remember, react to stress, and make decisions. It also makes addiction incredibly difficult to overcome.
Addiction is clearly an illness, not a moral weakness. That’s why the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the gold standard of mental health diagnostic tools, includes “substance use disorder” as a treatable medical condition.
What Is a Substance Use Disorder?
Based on our new understanding of addiction, physicians now treat it as a disease. According to the DSM-5, a substance use disorder diagnosis involves:
- Taking a substance in larger amounts or for a longer period than intended
- Unsuccessful attempts to cut back or stop using the substance
- Significant time dedicated to getting, using, and recovering from the substance
- Cravings and urges to use
- Failing to meet your major work, school, and home obligations
- Continuing to use even when your substance use harms your relationships
- Giving up your hobbies, work activities, and social engagements because of substance use
- Using in situations that put you at risk of physical harm
- Using even when you realize it is harming your mental and physical health
- Increased tolerance to the substance’s effects
- Withdrawal symptoms
If you have two or three of these criteria, you have a mild substance use disorder. Six or more symptoms suggest that your substance use disorder is severe.
Unfortunately, it’s all too easy to develop a substance use disorder. Many people take opioid or narcotic medications while recovering from surgeries or dealing with chronic pain. Our bodies can quickly become dependent on these medications, leading to addiction.
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People With High-Stress Jobs Have Higher Rates of Substance Abuse
Approximately 10% of all adults qualify for a substance use disorder diagnosis, although the vast majority never get treatment. Many professionals in high-stress fields report especially high levels of alcohol and drug use. For example, in a 2017 survey, performed by the Hazelden Betty Ford Foundation, about 15.4% of surgeons reported unhealthy drinking. A shocking 36.4% of lawyers had a recent history of unhealthy alcohol consumption.
It can feel hard to step away from your job and income when you’re in a high-profile position. However, without treatment, your addiction or alcohol dependence can take control, leading to life-changing losses. To help provide financial stability while you focus on your health and sobriety, you may be able to turn to your disability insurance policy.
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Does Short-Term Disability Cover Substance Abuse Treatment?
Typically, your healthcare insurance will cover some or all of your inpatient or outpatient substance abuse treatment. However, your healthcare plan won’t offset your lost income while you’re in rehab. For financial support, many professionals turn to their disability insurance policies.
Short-term disability insurance is supposed to step in and provide monthly benefits if you’re unable to work due to a chronic condition, injury, or illness. While some policies exclude claims that solely involve substance use, most disability insurance policies cover disabilities due to substance use and addiction.
To receive short-term disability benefits, you’ll need to prove that your alcohol or drug addiction is disabling. Depending on your policy’s terms and conditions, “disability” will be defined in one of two ways:
- Own occupation: Your substance use disorder prevents you from doing your actual job.
- Any occupation: Due to addiction and your other medical conditions, you cannot perform any type of full-time work.
If you qualify, your insurance company will pay you a monthly benefit while participating in therapy and addiction rehabilitation.
However, you’ll need to substantiate your claims. It’s best to provide a clear medical diagnosis along with documentation from a licensed doctor, psychologist, or therapist that details your struggles with alcohol dependency or addiction. (The insurance company will not pay your short-term disability benefits if you simply claim that you’re struggling with addiction and take time off to go “cold turkey.” You’ll need to show that you’re undergoing substance abuse treatment with a medical professional.)
Will I Lose My Job if I Seek Substance Abuse Treatment?
Under certain circumstances, the Family Medical Leave Act (FMLA) and Americans with Disabilities Act (ADA) will cover your fight with addiction. If you’re a covered employee, you can qualify for up to 12 weeks of unpaid leave during the year. Similarly, you may be entitled to reasonable accommodations and other protections under the ADA. However, these laws are remarkably complex, and you should always consult a lawyer if you have questions about your employment rights.
Can I Get Long-Term Disability for Alcohol or Drug Addiction?
Unlike the Social Security Administration, which will not cover substance use if it’s material to your disability, you may be eligible for employer-funded or private long-term disability benefits. However, there are usually limitations to this coverage. For example, many insurance companies limit LTD benefits for substance use disorder to two years of benefit payments.
Before you apply for long-term disability benefits, you should carefully review your current policy documents. This will help you understand whether you’re likely to face benefit limitations or exclusions. If you need help interpreting your plan’s terms and conditions, you should schedule an appointment with an experienced long-term disability lawyer.
4 Ways Insurance Companies Try to Deny Claims Involving Substance Use
Even if your policy offers broad benefits for substance use claims, insurance companies will frequently fight against paying those benefits. Some common reasons insurance companies deny substance use claims include:
- Claiming your substance use is a preexisting condition.
- Minimizing your other disabling conditions, especially physical disabilities.
- Arguing that your disability is “self-inflicted.”
- Deciding that you’re non-compliant when you relapse.
To counter these arguments, you’ll need help from an experienced disability lawyer who understands how to interpret long-term disability policies, evaluate substance use claims, and analyze your complex medical history.
The team at Bryant Legal Group takes a practical and sophisticated approach to claims involving alcoholism or drug addiction. We’ll carefully review your medical records, consult with experts, and review the relevant policies line-by-line. Then, using our extensive knowledge and experience, we’ll build a plan that focuses on getting you the support you need.
Bryant Legal Group: Fighting for Disabled Workers and Their Families
At Bryant Legal Group, our disability insurance lawyers have decades of experience handling claims involving substance use disorders. We apply this experience on behalf of our clients with the goal of supporting their ongoing recovery.
If you have questions about disability insurance and addiction, our lawyers can help you understand your options. We treat all of our clients with the utmost respect and offer practical solutions to their disability-related matters.
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