Disability insurance companies don’t always make it easy for policyholders who have a substance abuse disorder or other mental nervous conditions to get the disability benefits they deserve.
What Is A Substance Abuse Disorder?
A substance abuse disorder, also called a drug use disorder, is a condition in which the use of one or more drugs or alcohol leads to clinically significant impairment or distress. It is characterized by a pattern of “continued pathological use” of a substance that results in adverse social or work consequences.
Substance abuse can involve drug or alcohol abuse alone or can result from prescriptions given to control pain caused by other medical conditions. Physicians, for example, will prescribe strong addictive narcotic medication to help control back pain, which can result in a substance abuse disorder.
How Disability Insurance Companies View Substance Abuse Disorder Claims
Disability carriers will deny substance abuse claims on the basis that:
- Drug and alcohol abuse can be controlled and resolved with treatment,
- Substance abuse is a psychological and not a physical condition,
- Substance abuse is the manifestation of depression, schizophrenia or bipolar disorder.
Many substance abuse disorder disability claims are also denied because the disability insurance company says:
- There is no objective basis of the diagnosis,
- There is no objective basis for the restrictions and limitations assigned by your physician, or
- There is no causal relationship between your symptoms and/or your restrictions and limitations, and your inability to do your own or any occupation.
Why The Definition of Mental or Nervous Conditions In Your Policy Is Key
If there is no mental nervous limitation in your policy that includes substance abuse disorder, you are lucky. You will be eligible for benefits for the life of the policy if you remain disabled.
How your policy defines “mental illness” or “nervous conditions” is key to how long you get disability benefits. Many policies limit benefits to 24 months.
There is NO uniform policy definition for these terms, and many were written poorly. Some disability insurance policies define mental illness as:
- “Any psychological, behavioral, or emotional disorder,”
- “Any disorder found in the current diagnostic standards manual of the American Psychiatric Association.”
Other policies list conditions they have decided are mental or nervous conditions and list other conditions they have decided are not. That may or may not include substance abuse
It is not uncommon for Ms. Cavey to represent a policyholder who has substance abuse disorder and back pain or other disabling medical problem. Some policies also limit benefits to 24 months if any mental nervous condition contributes in any way to your overall disability.
Nancy Cavey, who has 35 years experience handling disability cases, has battled often with disability carriers about these ambiguities. Courts have reached many different decisions on what mental nervous policy terms mean. It is crucial you know what the courts will do before you apply for benefits, and that you fill out your application properly.
She works closely with you, your family and your physician to overcome a claims denial or termination of benefits after 24 months.
Nancy Cavey offers a free initial consultation and welcomes the opportunity to speak with you about your disability claim.
Don’t forget the carrier will do a file review months before the 24-month limitation runs. They will be looking in your medical records for continuing substance abuse problems so they can say, “Got you!”
If possible, Ms. Cavey will make sure that any physical disability is well developed in your medical records and that your doctors properly comment that you are NOT disabled as a result of substance abuse or any mental condition.
How Do I Get The Disability Insurance Benefits I Deserve?
It takes teamwork!
Substance abuse disorder can make it difficult, if not impossible, to do things around your home and work. Substance abuse disorder can damage and even destroy professional relationships and result in poor work performance.
If you no longer can work or your doctor has told you to apply for disability benefits, you should take steps before you apply:
- Obtain a copy of your disability policy. See how it defines “disability,” “occupation” and “self-reported conditions.” You’ll need to understand what you have to prove to get your benefits because of substance abuse disorder or any other mental or nervous condition.
Your policy can include a mental/nervous limitation that classifies substance abuse disorder as a mental disorder, or the policy can be silent on the issue. You’ll want to know what your policy says before you apply for benefits. You’ll also want to know if the policy limitation applies if your mental nervous condition contributes to your disability in any way.
- Obtain a copy of your medical records. Review them to see if there is an objective basis for your diagnosis, what your records say about your report of symptoms and your restrictions and limitations. Psychological testing should be included in your records.
- Obtain a copy of your personnel file to see if your substance abuse disorder has affected your work performance.
- Obtain a copy of your job description. Create your own description of your physical duties with an explanation of how your symptoms impact your ability to do your occupation.
- Provide your doctor with the occupational description. Ask your doctor to prepare a report that explains the objective basis for your diagnosis, the objective basis of your restrictions and limitations, and the objective reasons you can’t perform some or all of the material and substantial duties of your occupation.
- Prepare a diary that explains and gives examples of how your symptoms interfere with your ability to do things on a daily basis and the side effects of your medication.
If you can’t prepare and keep the diary ask a family member, friend or a co-worker to help you. This is important because what makes you disabled is the change in your behavior as your symptoms progress. You may have difficulty performing your work or activities at home, become socially withdrawn, become overactive, get into altercations or do things that are just unusual for you.
- Hire Nancy Cavey to help you file your initial application. The application process is confusing and designed so you and your physician make mistakes that can result in a delay or even a denial of your benefits. Ms. Cavey knows how to prepare and file a winning shock and awe disability application that leaves the carrier little reason to question your claim.
- Hire Nancy Cavey to help you appeal a wrongful denial or termination of your disability benefits. Disability carriers are in the business of collecting premiums and not paying disability benefits. Carriers routinely cut off benefits at 24 months and misapply the mental nervous condition limitations.
They’ll use any reason to deny your claim. The odds of getting your benefits on appeal are greater when you are represented by an experienced ERISA/private ID policy disability attorney.
Contact Disability Attorney Nancy L. Cavey, Who Can Help You Regardless of Where You Live
Substance abuse disorder can make it difficult, if not impossible, to work. You owe it to yourself and your family to get help today! Nancy Cavey can review your policy and your medical records, and explain to you what your policy says and how to get your disability benefits. Call today for a free consultation at 727-894-3188.