This article contains general information and is not legal advice. For qualified legal advice, please call 604-876-7000 to get in touch with a BC Disability Insurance Lawyer near you.
*Please note that if you are a union employee and are subject to a collective agreement that references a disability insurance plan, you should immediately discuss your claim with your union representative. Our firm may not be able to assist in these situations. Limitation periods can be very short—sometimes weeks—when a union grievance process is available.
If you are living with a substance use disorder and find yourself unable to work because of it, you may be wondering whether you qualify for disability insurance.
The answer is complicated. Claims involving addiction and substance use are among the most legally and medically complex types of disability insurance matters in British Columbia. Every scenario is different, and even the smallest change in circumstance can affect what you can do legally. That’s why we always recommend getting legal advice before doing anything else.
But if you’re just looking for more information, this article can help you understand:
- How disability insurance policies may respond to substance-related conditions
- What insurers typically look for
- When it may be worth speaking with a substance abuse disability lawyer about your situation
Is Substance Abuse Considered a Disability in British Columbia?
Substance abuse, known medically as substance use disorder, is recognized as a disability in Canada, including British Columbia.
It’s important to keep in mind that using substances doesn’t necessarily mean you have substance use disorder. Substance use disorder is characterized by harmful, excessive, and difficult to control substance use, affecting your ability to maintain your health, relationships, and responsibilities.
While it is recognized as a disability in medical terms, disability insurance does not always follow medical definitions. Your disability insurance policy relies on the policy definition, more about this below.
Is Substance Abuse Covered Under Short-Term or Long-Term Disability?
One of the most common questions people ask is: is substance abuse covered under short-term disability? The answer depends heavily on the specific wording of your policy.
Some employer-sponsored short-term disability plans may provide limited benefits during an initial period of treatment or medical leave, while others contain specific exclusions or limitations related to substance use disorders.
Coverage can also vary based on whether you have been diagnosed, whether you’re actively getting treatment, and how the policy defines disability. In some cases, substance use disorder does not fall into the policy’s definition of disability.
If you are having trouble understanding how your policy works and whether your substance abuse qualifies, our team of lawyers can help.
How Insurers Assess Substance Abuse Disability Claims
When a disability claim involves a substance use disorder, insurers tend to look closely at several factors. Understanding what they consider may help you prepare your claim.
- Medical diagnosis and documentation: A formal diagnosis from a qualified physician or specialist is usually required. The insurer needs this documentation to understand the nature and severity of the condition.
- Functional limitations: The insurer will assess whether the condition is actually preventing you from performing your job duties. Documentation of how the disorder affects your day-to-day functioning is critical.
- Treatment participation: Insurers often require evidence that a claimant is actively in treatment, usually through inpatient rehabilitation, outpatient counselling, or medically supervised detox programs.
- Physician support: Insurers usually will look for a qualified physician’s opinion about your ability to work and the need for leave. This will help your insurer verify the medical severity of your substance abuse.
- Policy limitations and exclusions: Some policies specifically limit or exclude coverage for conditions related to substance use. That’s why it’s important to review the policy carefully with a lawyer.
Why Substance Abuse Disability Claims Are Denied
Disability claims involving substance use disorders can be denied for a variety of reasons.
- The policy contains a specific exclusion for substance-related conditions
- Insufficient medical evidence to demonstrate functional limitations
- The insurer takes the position that the claimant is not fully compliant with recommended treatment
- A relapse during the claim period, which the insurer interprets as a failure to meet policy conditions
- Discrepancies between the claimant’s reported limitations and what the insurer’s medical reviewers conclude
- The insurer determines that the claim does not meet the policy’s definition of total or partial disability
A denial does not necessarily mean your claim has no merit. Insurers can and do make decisions that claimants successfully challenge through appeals or legal action.
Mental Health Conditions That May Accompany Substance Use Disorders
People with a mental illness are twice as likely to have a substance use disorder compared to the general population. As such, disability insurance cases involving substance abuse are often accompanied by other mental health issues, such as depression, anxiety, PTSD, and bipolar disorder. Clinically, this is referred to as a concurrent or co-occurring disorder.
When a disability claim involves both a substance use disorder and a diagnosable mental health condition, the claim becomes more nuanced. In some cases, the mental health condition may independently support a disability claim, depending on the policy terms and the supporting medical evidence. In other cases, the insurer may attempt to evaluate the two conditions together.
Regardless, it’s important to evaluate and include relevant documentation for co-occurring substance use and mental disorders. This will give insurers a fuller picture of your functional limitations.
Frequently Asked Questions
Can alcoholism qualify for long-term disability benefits?
Yes, alcoholism could qualify for long-term disability benefits, but it ultimately depends on the policy, medical evidence, and functional limitations involved. Alcohol dependency can be a serious medical condition with significant impacts on a person’s ability to work. However, insurers will assess each claim individually, and a successful claim is not guaranteed.
Can a relapse affect disability benefits?
A relapse can potentially complicate an ongoing disability claim. Some insurers interpret a relapse as non-compliance with treatment requirements, which could affect the continuation of benefits. However, the impact of a relapse on a claim will depend on the policy terms, the circumstances, and the medical context.
Clinically, relapse is a medically recognized aspect of recovery from substance use disorders, and an experienced lawyer may be able to help in the event of a claim dispute caused by a relapse.
What to Do If Your Substance Abuse Disability Claim Was Denied
Unfortunately, disability insurance denials for claims involving substance abuse are not uncommon, but it doesn’t mean you need to give up. Insurers are not always justified in their denials, and there are various legal options available if that’s the case.
Here’s what to do after being denied:
- Review the denial letter carefully to understand the specific reasons the insurer gave for denying your claim.
- Get legal advice from a disability lawyer at Dyson Law. We specialize in complex disability insurance disputes, and will tell you honestly whether it makes sense to challenge the denial legally.
- With the help of a lawyer, gather additional medical documentation that can address gaps or concerns related to the denial.
Before You File an Internal Appeal
You can file an appeal with the insurer internally, but be careful. The limitation period for legally pursuing disability benefits is short, and any delays could mean you lose your claim forever (even if you were wrongly denied).
We recommend consulting with a lawyer before and while filing internally. Disability insurance providers can be slow to respond to internal appeals, and if you were denied wrongly, will likely maintain their denial. In order to protect yourself legally and understand your options, you should get legal advice as soon as you can.
Our lawyers are happy to help you understand your situation and whether you have grounds to dispute the denial in British Columbia court.