Substance Abuse & Denied Disability Benefits

Substance Abuse Denied Disability Lawyers in Hamilton, Ontario.

By Matt Lalande, Esq

We understand that alcohol addiction is not a choice. Drug addiction is not a choice. Opioid addiction is not a choice. Substance abuse and opioid addiction is widespread and of major impact in our society. Addiction can no doubt have a disabling effect on a person’s life.  The effects of any type of substance abuse can be detrimental to an addict, impacting their social, personal, and work life simultaneously.

Insurance companies routinely deny claimants with substance abuse issues, but don’t give up the fight! We can help restore your monthly income.

On the other hand, many policies typically have exclusionary clauses that are quite clear that no Long Term Disability Benefit are payable for disabilities that result from alcohol, drug or other substance use disorder, unless the claimant is receiving and complying with continuous treatment for such total disability from a rehabilitation centre, a provincially designated institution, or is actively involved in and following a program of rehabilitation which is supervised by a Physician and approved by the long term disability carrier.  So, sadly, alcohol and drug addiction remains a misunderstood form of disability, with even insurance companies denying claims relating to substance abuse due to policy definition when the reality is that short-term and long-term disability benefits can make a real difference for a person who is struggling to remain healthy and sober.

Then there’s the reality – with an example.  Often times drug or alcohol abuse, or opioid abuse is of the result of an underlying problem whether it be an underlying condition, psychological abuse, physical abuse or harassment ect.  There could me major depression, anxiety related illnesses, chronic mental or psychiatric issues or the claimant could be suffering from a life-changing injury that caused the abuse of pain medication.

Take the case of Tanious v. Empire Life Insurance Co out of BC. In this case, the claimant was denied benefits. The claimant was initially diagnosed with multiple sclerosis (MS) in February 2005, having been healthy until that point. It was reported that the MS became progressively worse until her termination in January 2012. It was noted that during this time, she self-medicated with use of crystal meth after her diagnosis which led to her erratic behavior and eventual termination.  Prior to being fired, her family doctor determined that employee could no longer work.  She was terminated approximately two weeks later. The LTD carrier, Empire Life denied payment of her long-term disability benefits on the basis that the crystal meth caused her disability, not her MS.   There was objective evidence presented at trial that her MS had progressive effect on her brain and mental functioning since diagnosis and that depression, anxiety, and fatigue were accepted symptoms of MS and these were experienced by employee in consistent manner. At trial the Judge found that the MS was the underlying condition which precipitated the claimant to use drugs. Aggravated damages were also awarded.

If you are suffering from an addiction, long-term benefits may be just the help you need to help pay your bills while you can get the appropriate treatment, enter a program and work toward beating your illness.  Unfortunately, all too often we see people who are denied their claim and end up stressed, depressed and unable to resist their mental health addiction.

At Lalande Personal Injury Lawyers, we have compassion for your addiction and struggles and work hard to ensure you get the help you need to succeed.  If you have been denied or cut off long-term disability due to a serious substance abuse addiction, we can help – no matter if you are suffering from opioid addiction, alcohol addiction or drug addiction.

The Life-Altering Effects of Addiction and Substance Abuse:

Those suffering from alcoholism and/or drug addiction may find themselves on a roller coaster that consists of periods of sobriety alongside times when they lose the battle with their addiction.  Every day can be a struggle to stay sober and clean.  Rehabilitation treatment programs are often needed to provide the tools for a clean lifestyle.  Without proper treatment and assistance, it can be difficult and even impossible to maintain a clean, sober and healthy lifestyle.

Substance Abuse Disorder

The DSM-V is the latest version of the American Psychiatric Association’s gold-standard book on everything mental illness—including addictions. How does the DSM classify substance abuse disorder?

The DSM 5 makes notes of various substance abuse disorders resulting from the use of ten classes  – being

• alcohol;
• caffeine;
• cannabis;
• hallucinogens (such as LSD);
• inhalants;
• opioids;
• sedatives,
• hypnotics;
• stimulants (like cocaine) and
• tobacco

Addiction is a serious disorder that can make it increasingly difficult to maintain a job, a home life, obligations and relationships. From a work perspective, a serious addiction may impact on a person’s judgment, attentiveness, awareness or emotional well- being which in turn, can impact a safe work environment or logical decisions. Alcohol additions can lead to major hang-overs and withdrawal which affect job performance.

Opioid addiction can lead to major productivity and workplace safety problems which can be damaging to individual employees and their co-workers. Other substance abuse problems that can lead to workplace issues are constantly being late, substandard decision making, efficiency loss, morale issues, disciplinary issues and increased likelihood of attention and concentration difficulties.

Substance Abuse and Disability Benefits

As noted above, it is important to understand that many policies do not have coverage for absenteeism because of substance abuse. However, many cases have overlapping or underlying causes of the substance abuse that may be in fact meet the definition of total disability. For example, many people turn to alcohol because of major depression issues. Many people turn to opioids because of pain related issues. They turn to drugs and alcohol because something is terribly wrong. A Court could be asked to determine whether alcoholism is a cause, effect or exacerbating factor with respect to your total disability. In other words, was your alcoholism secondary to your psychological issues or was your alcoholism grounds for excluding coverage based on the policy’s alcoholism and substance abuse exclusion clause.  These types of situation absolutely require a Hamilton disability lawyer to marshal the appropriate medical evidence and expert opinions to allow a Court to make an informed determination when confronted with overlapping proximate causes of disability.

Was Your Disability Claim Denied for substance abuse?

Insurance companies regularly deny disability claims related to substance abuse, especially long-term claims. If this is something you are currently experiencing, an experienced Hamilton denied long-term disability lawyer can help. Generally, when an insurance company denies a claim based on alcohol or substance abuse they do so by policy exclusion.  Your entitlement to receive benefits will depend on the provisions of your specific policy. Under some group policies, addiction can be classified as a disability which would entitle you to receive disability benefits, provided you are actively participating in a treatment program.

If you have been denied or cut-off short or long term disability before or after the change of definition, you need an experienced Hamilton lawyer to help provide you with your best options.  Our Hamilton long-term disability lawyers have litigated against all major insurance carriers with favorable results. Over the past 15 years, Matt Lalande has recovered millions of dollars in insurance benefits and payments for people who have been denied an insurance claim. We help people throughout Ontario get the insurance benefits they are entitled to.

We offer a free consultation, and remember, you don’t pay until your case is settled.  Please feel free to call us at 905-333-8888,  fill out one of our contact forms, or feel free to speak with our live operator 24/7.