Personal Injury Law
Long Term Disability Arising from Addiction
Personal Injury Law
Long Term Disability Benefits For Addiction
Most people now consider addiction a disease, and that the victim often does not have a choice in the matter. However, some insurance providers might still reject your long-term disability claims for addiction. Their policies might exclude addictions and substance abuse ailments from the list of conditions covered. If you feel that your claim for disability benefits was unjustly denied, approach our long-term disability lawyer to fight for your rights and obtain the full amount of benefits you are entitled to.
At Nanda & Associate Lawyers, we are known for our ‘No Win, No Fee’ policy, letting our clients focus on their recovery without worrying about the legal expenses. For more than 20 years, we have helped numerous clients obtain maximum compensation in their personal injury cases, allowing them to rebuild their lives after an accident or injury. With our experienced personal injury lawyers handling your case, you will get the peace of mind you deserve! Connect with our personal injury lawyers today.
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Treatment for addiction
The treatment for addiction and substance abuse cases generally consists of counselling, medication, and rehabilitation. In most cases, it might be required to confine the patient to a rehabilitation facility until he makes a full recovery. Even after rehabilitation, regular supervision and follow-ups will be required to ensure that the patient does not relapse. As you can imagine, all this can be very expensive, especially since the patient is temporarily unable to work because of his condition. It is, therefore, important that they receive the long-term disability benefits to help them get through this ordeal.
How can our disability lawyer help you?
Assistance with submitting the claim
If your policy covers addiction, promptly inform your insurance provider and submit the claim for benefits as soon as possible. Your lawyer will help you prepare the claim and get the necessary supporting documents from your medical team. In long-term disability benefits claims, you not only need to prove that you are suffering from the condition mentioned but also show how your condition impairs your ability to perform your job. If you meet the criteria mentioned under the policy, your lawyer will help you secure the maximum benefits you are entitled to.
Legal assistance in case of rejection
If your insurance provider rejects your application for long-term disability benefits, you need to consult with our personal injury lawyer to figure out your options. For example, if the insurance provider was questioning whether your condition had any effect on your ability to work, you need to submit more medical records to substantiate your claim. However, if you feel that your claim was unfairly rejected, you might have to pursue other options.
One option is to file a complaint with the OmbudService for Life and Health Insurance (OLHI) against the insurance provider for the unfair rejection of your application. Another option is to file a civil lawsuit against them in court. Follow the advice of your personal injury lawyer in deciding the best course of action in your case.
How We Can Help
Contact our personal injury lawyers for any assistance or guidance on your addiction disability claim. Schedule an appointment with our personal injury team for a consultation today.
Frequently Asked Questions
Is addiction considered a long-term disability?
Addiction and other mental health illnesses no longer carry the stigma they once did. The medical community started classifying addiction as a disease many decades ago. Many insurance companies have already started taking the same view. If your insurance provider has mentioned addiction as a long-term disability in the terms and conditions of the policy, then it is treated as such. You may go ahead and submit your claim. In other words, everything depends on the agreed-upon policy document between the insured and the insurance provider. However, in some cases, it is the employee who is hesitant to reveal the addiction or substance abuse problem he is suffering from. This is out of fear that the history of such an illness might adversely affect his future employment prospects.
What are some of the common reasons for denying the claim?
- Policy exclusions mentioned in the document. Some insurance providers include substance abuse and addiction in the excluded conditions list. You need to check the document to make sure that this is the case. However, if the policy already covers the condition that led to your addiction, you have grounds to contest this denial. For example, some cancer patients suffer from depression and get addicted to antidepressants during the long recovery.
- The insurance provider dismisses addiction as a result of voluntary behaviour. Often, the insurance provider will contest the claim and argue that the patient was voluntarily taking drugs and eventually got addicted to them.
- Patient’s failure to adhere to the treatment requirements. A patient suffering from addiction will often relapse back to it, thus discontinuing the treatment regimen he was undergoing. The insurance provider may use this as a rationale to reject your claim.
What are your options in the event of a rejection?
- Rectify the issues raised in the letter of rejection. The insurance company will send you a letter of rejection if they reject your claim. The letter will include the reasons for the rejection. For instance, your insurance provider might assert that you are not following your doctor’s recommended treatment. If this is not true, a doctor’s letter and treatment records may fix it. Your disability lawyer will help you prepare your appeal and ensure that it is submitted before the deadline prescribed in the policy document.
- Verify your medical condition with an Independent Medical Expert. If the insurance provider is questioning your medical condition and its effects on your ability to work, getting verification from an independent medical examiner should clarify the issue.
- Approach regulatory authorities or the courts. If you believe the rejection of your claim was unjust, consider filing a complaint with regulatory authorities such as OmbudService for Life and Health Insurance (OLHI). Filing a lawsuit against the insurer for bad faith or breach of contract is also an option. Follow the guidance of your lawyer in deciding which course of action to pursue.
How long will it take for the insurance company to approve the claim?
This varies on a case-by-case basis. Generally, if your application and all your documents are in order, you should start receiving the benefits payment in a few weeks. Instead, if you start receiving queries from the insurance company for more documents and evidence, then you can expect the process to drag on for a few more months. In such cases, you can pursue the option of applying for short-term disability benefits to take care of your medical expenses and other immediate expenses. The same rule applies to the appeals process.
How long will the long-term disability benefits coverage last?
This might vary from policy to policy. In most cases, the long-term disability benefits will continue either until you are fit enough to return to work or until the policy coverage expires. Some policies offer coverage until the retirement age of 65, while others only offer coverage for a maximum of 5 to 10 years. Read the policy document carefully to confirm the duration of your disability benefits applicable in your case.
What is the difference between “own occupation” and “any occupation” disability tests?
When you are applying for long-term disability benefits, you will be required to prove that your medical condition has affected your ability to perform the tasks associated with your current job. Typically, once your claim is approved, you will start receiving your long-term disability benefits for a period of two years. Most insurance providers will expect you to go through some vocational retraining in order to qualify for any other jobs. After the two-year period, your ability to work will be reassessed for you to continue receiving the long-term disability benefits. However, now you will have to prove that you are unable to perform any job suited to your work experience and qualifications. If not, your disability benefits are likely to be discontinued.
