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Opioid Addiction and Individual or Group Disability Benefits: Limitations on Substance Abuse Claims

Opioid addiction and long term disability attorneys

The National Institute on Drug Abuse reports that almost two-million Americans suffer from an opioid-related disorder. In fact, 25 percent of patients with legally prescribed opioid pain medications may misuse them, and about 10 percent of those patients develop addictions.

Many opioid users don’t know that these medications do more than relieve pain. Opioids such as oxycodone can alter your brain chemistry in ways that ordinary pain medications like aspirin and Tylenol don’t. Opioids interact with your brain’s nerve cells to produce pleasurable effects that also improve your mood and make them addictive. This is one reason that nearly 80 percent of heroin users report first abusing prescription opioids.

If you suffer from chronic pain as the result of neck, back, or knee issues, or a related condition, over-the-counter medications make a poor substitute for much stronger opioids.

Many long-term disability insurers classify an opioid or substance abuse problem as a self-inflicted injury, but this isn’t always the case. Some of the nation’s largest opioid manufacturers and distributors are now facing a significant class action lawsuit in Ohio and other states. The federal lawsuits are based on evidence showing that drug companies lied and failed to effectively warn users about the addictive nature of opioid medications. As a result, opioids were widely prescribed to relieve pain when most users did not know that the drugs altered their brain chemistry.

If you suffer from an addiction to prescription pain medication, you may qualify for individual or long-term disability benefits through your individual or group long-term disability plan. Individual and group long-term disability policies replace a percentage of your salary or hourly wage during your eligibility period, which hopefully can give you time to adequately recover. To schedule your free, confidential disability policy analysis and free claim consultation with one of the top-rated long-term individual disability attorneys and award-winning group ERISA lawyers at DarrasLaw, call us today at 800-898-7299 or contact us online.

Individual and Group Long-Term Disability Benefits and “Self-Inflicted” Injuries

Just because you’re disabled and unable to perform the important duties of your occupation doesn’t mean you’re disabled under the terms and limitations of your individual or group long-term disability insurance policy.

Often, you cannot generally obtain individual or group long-term disability benefits for “self-inflicted” injuries. The definition of a self-inflicted injury depends on the terms and limitations of your individual or group long-term disability plan, but it can include:

  • Attempted suicide
  • Injuries purposefully inflicted to obtain individual or group long-term disability
  • DUI or DWI related injuries
  • Injuries obtained as the result of recklessness
  • Certain substance abuse injuries and illnesses

Drug addiction opens the question as to whether the condition was “self-inflicted.”

Most addicts never took prescription medications with the intent to develop an addiction. Instead, many addicts may have suffered from chronic conditions, such as back pain, and needed the medication to function. The majority of opioid addicts were already in pain or even disabled before their addiction developed.

You may successfully argue that your addiction is a symptom of an underlying disability and not the disability itself. Most individual and group long-term disability insurance policies recognize that once you’re addicted to prescription medications, you can’t stop on your own. However, they may claim that failing to fight the addiction before you become disabled constitutes a choice.

Substance abuse conditions are hard to classify in the context of individual or group long-term disability benefits, which is why most disability insurance companies offer an alternative benefits scheme.

Substance Abuse as a Self-Reported Condition

If you qualify for individual or group long-term disability benefits, your policy may entitle you to payments as long as you suffer from the disabling illness or injury. Under many long-term individual or group disability policies, a total disability, such as a traumatic brain injury, may result in individual or group long-term disability payments until retirement age. Your individual or group long-term disability insurer will likely offer you a lump-sum settlement in these cases. Always consult an experienced long-term disability lawyer or nationally acclaimed ERISA attorney at DarrasLaw to ensure you receive an adequate lump-sum settlement.

When it comes to substance abuse, however, your individual or group long-term disability insurance company will typically cap your benefits at 24 months or less. This is the balance that was struck between opioid addiction as a disability and drug abuse as a self-inflicted condition.

Opioid addiction and substance abuse disabilities, however, often intertwine with each other, and can be difficult to clinically diagnose. These self-reported disabilities are diagnosed by how claimants report their pain and how their ability to perform the important duties of their occupations is impaired. Such conditions include, but are not limited to:

Most individual or group disability insurance policies will not reset your 24 months of eligibility if you develop another “self-reported” condition. This means that, if you received 24 months of individual or group disability benefits for your fibromyalgia, you can’t take another 24 months of benefits to treat the opioid addiction that developed as a result.

What if you accidentally overdose on pain medication and suffer brain or heart damage? Do you now have a claim for individual or group long-term disability benefits independent of your addiction? Your individual or group long-term disability insurer may say no, but the award-winning long-term disability attorneys and ERISA lawyers at DarrasLaw would strongly disagree.

Contact Us Now for a Confidential Individual or Group Long-Term Disability Consultation

When you suffer from an opioid addition, your first priory is to get well. However, you’ll need time to adequately do so. You probably didn’t start taking prescription pain medication on your own—your treating physician prescribed it for a medical or psychiatric reason. Whether you suffer from a painful underlying condition or did not know about your medication’s addictive effects, the experienced long-term disability attorneys at DarrasLaw can help you fight. It’s not uncommon to face a wrongful delay, denial, or termination of individual or group disability benefits when you have a substance abuse disability. However, having this condition doesn’t mean you’re not entitled to relief under your individual or group long-term disability plan.

America’s top disability lawyer, Frank N. Darras, has more than 30 years of litigation and claim experience fighting for America’s disabled. He and his firms have recovered nearly $1 billion in wrongfully delayed, denied, and terminated insurance benefits. To schedule your confidential, free disability policy analysis and free claim consultation with some of America’s top-rated group ERISA attorneys and individual disability lawyers, call DarrasLaw today at 800-898-7299 or contact us online.

DarrasLaw is Americas' most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long term disability and long-term care cases than any other lawyer in the United States.

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