An addiction disability lawyer can help if your short-term or long-term disability benefits have been denied, delayed or cut off.
An insurer may characterize alcohol or drug dependence as voluntary behaviour, allege that you failed to follow treatment or rely on an exclusion in your disability policy.
It may also overlook depression, anxiety, trauma, chronic pain or other conditions affecting your ability to work.
Samfiru Tumarkin LLP represents people with denied and terminated disability claims throughout Canada, excluding Quebec.
On This Page:
- How a Lawyer Can Help
- When to Contact a Lawyer
- Why Addiction Claims Are Denied
- Evidence for Your Claim
- What Happens Next?
- Frequently Asked Questions
How Can an Addiction Disability Lawyer Help?
A disability lawyer can review your denial letter, insurance policy and medical evidence to determine why the insurer refused or ended your benefits.
A lawyer may help by:
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Explaining the definition of disability in your policy
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Reviewing any substance-related exclusions or benefit limitations
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Identifying problems or inconsistencies in the insurer’s decision
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Determining what medical and treatment evidence is missing
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Addressing co-occurring mental and physical conditions
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Explaining the effect of relapse or unsuccessful treatment
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Communicating and negotiating directly with the insurance company
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Starting legal action when appropriate
Connecting Addiction to Your Work Limitations
A disability claim should explain why your condition prevents you from performing your actual occupation safely and consistently.
Cravings, withdrawal, sleep disruption, impaired concentration and mood symptoms may affect attendance, judgment, communication and productivity.
The risk may be particularly serious in occupations involving driving, machinery, health care, public safety, finances or emergency response.
When Should You Contact an Addiction Disability Lawyer?
Speak with a disability lawyer promptly if:
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Your short-term or long-term disability claim was denied
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Your approved benefits were later cut off
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The insurer says addiction is voluntary behaviour
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The denial relies on a substance-related policy exclusion
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The insurer alleges that you failed to follow treatment
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Your benefits are ending after detoxification or rehabilitation
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Depression, anxiety, trauma or chronic pain is being overlooked
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You are considering an internal appeal
You do not need to wait for another relapse, hospitalization or workplace incident before getting legal advice.
Do You Have to Appeal to the Insurance Company?
An insurer may invite you to submit an internal appeal after denying your addiction disability claim.
An appeal is not always the best option. The same insurance company that denied your claim will review it, and submitting similar information may produce the same result.
You may not have to complete the insurer’s appeal process before pursuing legal action. A disability lawyer can explain your options and applicable deadlines.
Why Are Addiction Disability Claims Denied?
An insurer may accept that substance use has occurred while disputing whether you have a disabling medical condition.
Common denial reasons include:
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The insurer characterizes the condition as a lifestyle choice
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The policy contains an exclusion or limitation
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The insurer alleges treatment non-compliance
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A short period of abstinence is treated as proof of recovery
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Relapse is treated as proof that treatment will not work
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Related mental or physical conditions are assessed separately or ignored
The Insurer Says Addiction Is a Choice
Addiction can impair a person’s ability to control alcohol or drug use despite serious consequences.
The insurer should assess the medical evidence, treatment history and functional limitations rather than dismissing the claim based on stereotypes.
The Insurer Relies on a Policy Exclusion
Some disability policies contain wording that excludes or limits benefits connected to alcohol or drug use.
The precise wording matters. An insurer may interpret an exclusion too broadly or fail to consider whether another disabling condition independently prevents you from working.
A lawyer can review the policy and determine whether the exclusion applies to your circumstances.
The Insurer Says You Failed to Follow Treatment
Disability policies commonly require claimants to participate in reasonable treatment.
However, missed appointments or an interrupted program should be considered in context. Relevant factors may include wait lists, treatment availability, cost, transportation, side effects and the effects of the medical condition itself.
The Insurer Says Rehabilitation Restored Your Ability to Work
Completing detoxification or rehabilitation does not automatically establish that you are ready to return to full-time employment.
You may require ongoing counselling, medication, outpatient treatment and a period of stabilization before a return is medically sustainable.
The Insurer Uses a Relapse Against You
Relapse does not automatically establish that you refused treatment or that disability benefits should end.
The insurer should consider the relapse in the context of the condition, treatment plan, recovery history and medical recommendations.
The Insurer Overlooks Related Conditions
Addiction may exist alongside depression, anxiety, post-traumatic stress disorder, bipolar disorder, chronic pain or physical illness.
Even when the policy limits benefits arising primarily from substance use, another condition may independently prevent you from working and must be properly assessed.
Your Benefits Are Cut Off After Two Years
Many LTD policies change their definition of disability after approximately two years.
The insurer may accept that you can’t return to your previous occupation but argue that you can perform another job.
It should consider whether another occupation is genuinely suitable and whether you can maintain its attendance, judgment, concentration and safety requirements consistently.
What Evidence Supports an Addiction Disability Claim?
A strong claim should document the medical condition, treatment and specific limitations preventing you from working.
Helpful evidence may include:
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Records from your family doctor, psychiatrist or addiction physician
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Substance use disorder assessments
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Detoxification, rehabilitation and outpatient-treatment records
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Counselling and medication-assisted treatment records
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Specific cognitive, behavioural, attendance and safety restrictions
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Evidence relating to co-occurring medical conditions
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A detailed description of your occupation
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Failed accommodations or return-to-work attempts
Document Your Treatment Efforts
Keep records of appointments, treatment programs, medications, wait lists and efforts to follow medical recommendations.
Where treatment was interrupted, document why and what steps were taken to find an alternative.
Explain Why You Can’t Work
A diagnosis alone may not provide enough information.
Your medical evidence should explain how cravings, withdrawal, sleep problems, concentration difficulties, mood symptoms and safety risks affect your actual job duties.
Document Unsuccessful Returns to Work
A brief return does not necessarily prove that you can sustain employment.
Document the hours and duties attempted, the symptoms or risks that emerged and why the return was stopped.
What Happens After You Contact an Addiction Disability Lawyer?
During an initial consultation, a disability lawyer may ask about your condition, treatment, occupation and the insurer’s reason for denying or ending your benefits.
The lawyer may review:
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Your denial or termination letter
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The definition of disability in your policy
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Any substance-related exclusions or limitations
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Your medical and treatment evidence
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Your job duties and return-to-work history
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Important dates and potential legal deadlines
The lawyer can then explain whether the insurer’s decision may be challenged and what additional evidence could strengthen your case.
How Can an Addiction Disability Claim Be Resolved?
Depending on the circumstances, a denied claim may be resolved through reinstatement of monthly benefits, payment of benefits previously withheld or a negotiated settlement.
There is no standard addiction disability settlement. The outcome depends on the policy, monthly benefit, medical evidence, treatment history, prognosis and other circumstances.
Is There a Fee to Speak With a Disability Lawyer?
Samfiru Tumarkin LLP offers a free initial consultation for denied short-term and long-term disability claims.
There are no upfront legal fees. You only pay if we successfully resolve your disability claim.
Frequently Asked Questions About Addiction Disability Lawyers
What does an addiction disability lawyer do?
A disability lawyer reviews your policy, medical evidence, treatment records and denial letter and helps challenge the insurer’s decision.
Can an insurer deny benefits because addiction is voluntary?
An insurer may raise this argument, but addiction can be a disabling medical condition. The claim should be assessed using the policy and medical evidence.
Can a policy exclude addiction claims?
Some policies contain exclusions or limitations involving alcohol or drugs. A lawyer can review whether the wording applies and whether other disabling conditions must still be covered.
Does relapse automatically end LTD benefits?
No. Relapse should be considered in the context of the condition, treatment plan and medical recommendations.
Do you have to appeal to the insurer first?
Not necessarily. An internal appeal is only one option. Speak with a disability lawyer before deciding how to challenge the denial.
Can a lawyer help before benefits are terminated?
A lawyer may provide advice when the insurer requests more information, questions treatment or warns that your benefits may end.
How long do you have to challenge a denial?
Legal deadlines apply and vary by province, policy and circumstances. Get legal advice promptly to protect your options.
Speak With an Addiction Disability Lawyer
Seeking treatment and working toward recovery can be difficult. You should not have to fight an insurance company alone while facing financial pressure and uncertainty about work.
Samfiru Tumarkin LLP represents people with denied and terminated disability claims throughout Canada, excluding Quebec.
Some members of our legal team previously worked for insurance companies. We understand why addiction and mental health claims are challenged and what evidence may be needed to dispute a denial.
For more information about eligibility and available benefits, read our guide to addiction disability claims in Canada.
Contact us for a free consultation if your short-term or long-term disability claim has been denied or cut off.