Modern pharmaceuticals have been responsible for many medical advances and helped improve the quality of life for many sick and disabled individuals, many of whom receive disability benefits from both the Social Security administration and private disability insurers. With all of the positive news, it is easy to overlook the cases of addiction and the life-long dependencies many of these drugs cause. When claimants become addicted to the medications they’re using to control their disability or disease, their claims for disability benefits can become much more difficult and challenging, subject to multiple delays or denials.
The most important issue to prove is the underlying physical or mental conditions that led to the prescription of the drug in the first place. If a claimant can show that he would still be unable to perform the duties of his profession without the drug use, it takes away many of the arguments the insurance company can raise. To look at it simply, it’s best to prove that the drug use has no direct bearing on your inability to the material and substantial duties of your occupation (or any occupation, depending on the type of coverage) and is just a side-effect or symptom of an underlying condition. As always, it’s important to demonstrate a physical basis for the disability if possible so that the insurance company cannot invoke benefit limitations due to mental/nervous or self-reported disabilities. There is a flip side to this coin as well. If you have experienced a mental or physical disability because of an addiction, you may qualify for benefits if you are no longer taking the abused drug. This is important in cases of permanent and irreversible damage, such as organ or nerve damage caused by past prescription drug use, that prevents you from working.
It is also possible to qualify for benefits if you can no longer work in your occupation or profession due to the risk of relapse from an addiction experienced in the past. This type of claim is extremely challenging. There are significant differences between states or circuits that may be the deciding factor in getting disability benefits approved or denied. Frankly, most pure risk of relapse disability claims don’t wind up being successful. We often see such claims in medical professionals, specifically anesthesiologists, who were and are able to access drugs on their own, without having to obtain a prescription. After recovering in rehab, the anesthesiologist may want to return to work but going back to work in his former occupation may not be possible due to his risk of relapse. Another common example of this type of claim is a physician who legitimately began taking pain medications after back surgery but continued to take the medication after his back healed, turning a legitimate use into an abusive drug habit. The denial of disability claims based only on a risk of relapse has become a standard defense tactic used by insurance companies. This argument has even been stretched to other impairments, such as cardiac based claims. It’s important to develop specific information for your claim and consult with an experienced disability claim professional or attorney before pursuing such a claim.
Insurance companies often defend against disability claims involving drug dependence in two ways: asserting that the disability is only a “legal disability” or that the disability is intentionally self-inflicted. These are both causes of disability that have been increasingly excluded from insurance coverage. Legal disability can loosely be defined as an inability to work in an occupation due to legal or license restrictions, rather than a factual disability. If drug abuse resulted in a doctor losing his medical license, the insurance companies will often invoke this defense – that the doctor would be able to practice except for the loss of his legal ability to practice. Insurance companies will often assert prescription drug abuse is an intentional self-inflicted disability and not subject to coverage. This argument can add insult to injury for an insured who has tried to quit but isn’t able due to physical or mental symptoms and dependencies. However, it is far easier to defend against a claim denial if the claimant has already started treatment from their addiction and is able to obtain a medical substantiation that he has become drug-free. Neither the insurance companies nor the courts are very sympathetic to claimants who are continuing to abuse their drug of choice.
Pharmaceutical addiction is a very real problem for millions of people, many of whom suffer in silence. Often, their fears are compounded when they try and obtain help for their disease, sending them into an even deeper tailspin. As a claimant, it’s vital that you understand your disability insurance before making a claim. Prescription drug abuse or addiction doesn’t automatically disqualify you from the disability benefits you deserve. Two of the most important pieces of evidence a claimant can develop to make sure a valid and appropriate disability claim isn’t denied due to drug abuse or addiction are to make sure that there is solid evidence of an underlying physical condition and that the prescription drug abuse or addiction is being treated or has stopped.
For more information on how our firm can help with any potential prescription drug issues in your disability claim, sign up for a free consultation here or call our offices toll-free at (855) 828-4100. If you’re struggling with prescription drug problems, please get professional help immediately. There are many resources available, such as this website, which can help locate treatment options near you. If you have any stories or additional advice, please fell free to share them in the comments section below.