Why Substance Use and Addiction Can Complicate Your Disability Claim

Jul 16, 2019 | Blog |

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. Today, substance use impacts every social, economic, and demographic group.

However, when substance abuse limits or eliminates your ability to work, you might find yourself battling your insurance company. Today, the disability professionals at Bryant Legal Group are going to explain how addiction can impact your long-term disability (LTD) claim.

The Science of Addiction

Some people still believe that addiction comes from a lack of willpower. However, scientists now understand that drugs can change how your brain functions. Most addictive substances affect your reward system — an instinctual part of your brain that helps you find and seek food and other essentials and pleasurable things. When you smell a barbecue and your mouth starts to water, your reward system has kicked in.

Substances like drugs and alcohol 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 recircuit your brain to prioritize substance use over your work, family, and health and wellness. This can change the way you think, remember, react to stress, and make decisions. It also makes addiction incredibly difficult to overcome.

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 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), a substance use disorder diagnosis involves:

  • Taking a substance in larger amounts or for a longer period of time 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 in 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 not hard 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.

RELATED ARTICLE: When Should I Speak With a Disability Insurance Lawyer?

Can I Get Long-Term Disability for Substance Use or Addiction?

While some policies do exclude claims that solely involve substance use, most disability insurance disability policies cover substance use and addiction. 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 disability insurance 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, schedule an appointment with an experienced long-term disability lawyer.  

RELATED ARTICLE: Common Insurer Justifications for the Denial of Private Disability Benefits

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 counteract 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 interpret your complex medical history.

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 physical and mental disabilities. We apply this experience on behalf of our clients, with the goal of getting them the benefits they deserve.

If you have questions about a Long-Term Disability claim, the team at Bryant Legal Group 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.

To request a free consultation, please contact our office by calling 312-561-3010 or completing this brief online form.


Bose, J., Hedden, S., Lipari, R., and Park-Lee, E. (2018, September). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report

Smith, F. (2017, September). How science is unlocking the secrets of addiction. National Geographic. Retrieved from https://www.nationalgeographic.com/magazine/2017/09/the-addicted-brain/

The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

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