Denied Claim For Contractor With Opioid Addiction

Denied Claim For Contractor With Opioid Addiction

All too often, long-term disability benefit claims are questioned when the cause is listed as addiction. Whether the addiction is in relation to a substance, an activity, or behaviour, it takes a strict adherence of application guidelines and practices for the claim to even be considered. Chief among those requirements is, perhaps one of its most limiting, the need to be enrolled in or show proof of enrollment in a rehabilitation program. Nevertheless, according to the Ontario Human Rights Commission (OHRC) “mental health issues and addictions are ‘disabilities’ that are protected under the [Ontario Human Rights] Code.”

Greg, however, didn’t know this when he applied for his disability benefits. A freelance business analyst who’d recently been hired for a one-year contract with a local media company, he decided to join the company soccer game. During the game he tripped and had his hand trampled by someone’s cleats. He was rushed to the hospital where some x-rays quickly confirmed his worst fear — he’d broken his hand. They needed to perform surgery and implant a metal plate to help stabilize the bone. The recovery wouldn’t be too strenuous, but in order to keep working, he would need to take Percocet to manage the pain. 

At first, everything was going fine. He was able to keep up with the daily demands of his job, aided by the Percocet in managing his pain. Occasionally, the pain would be too much to be able to sleep, so he’d take an extra pill to help. Eventually, he couldn’t sleep without the medication. After the first prescription ran out, his doctor agreed to give him a few more pills but refused to provide more beyond that for fear of addiction. His work started to suffer as he started having difficulty with concentration and coordination. This also limited his ability to help his partner, Joe, of 10 years around the house with basic chores. He found himself incapable of sleeping at night, and then oversleeping in the mornings, and often being late for work. After COVID-19 quarantine began he was able to work from home, but continuously missed deadlines, started late, and made frequent mistakes in his reports that started to affect the company. 

His boss scheduled a meeting to discuss his performance, and that he believed there to be something deeper going on and that Greg needed to get help. As a self-employed freelancer, Greg was not on the benefit plan at work.  He had purchased some insurance year before, and started looking for the policy.  He was weary of the application process for benefits, but with Joe’s help, he submitted the paperwork for long-term disability for addiction to opioids. Unfortunately, Greg’s claim was denied, since he hadn’t yet registered for a rehabilitation program, and the insurance deemed that such a quick addiction was unlikely, stating insufficient medical evidence. 

None of them had known that Greg needed to be registered in a rehabilitation program in order to be considered for coverage. As a result, his denied claim struck him painfully. But, with Joe’s help, they found Share Lawyers and came to us for help. We are helping Greg to fight the insurance company and his denied claim while assisting him in finding the right rehabilitation program that he can do on an outpatient basis. 

Has your long-term disability claim been denied? Contact Share Lawyers and put our experience to work for you. We have recently settled cases against Great-West Life, Desjardins, Manulife, RBC Insurance, Sun Life, and many more. We offer free consultations and there are no fees unless we win your case. Find out if you have a disability case.