Substance use affects every social, economic, and demographic group. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), millions of people in Illinois struggle with the misuse of substances. When alcoholism or other addictions impair your ability to work and support yourself or your family, it may feel like you’re facing a financial cliff at your most vulnerable state.
Many professionals in this situation turn to their short‑term disability (STD) or long‑term disability (LTD) insurance policies for income support. But the process is far from simple. Disability insurers often challenge claims tied to addiction or substance abuse. That’s where Bryant Legal Group’s disability insurance attorneys step in. We can help you understand your policy, navigate the claims process, and protect your rights when your insurer pushes back.
In this article we’ll address key questions such as:
- When and how can substance abuse lead to STD or LTD benefits?
- What are the important differences between STD and LTD in this context?
- What limitations or exclusions commonly apply to substance‑related claims?
- When should you contact a disability attorney?
- Practical steps to strengthen your claim and avoid common pitfalls.
What Qualifies as Alcoholism or Substance Abuse for the Purposes of a Disability Claim?
Medical professionals no longer view addiction as a moral failing or a matter of willpower. Rather, the process involves changes to brain chemistry and function, particularly in areas that govern reward, motivation, and decision‑making.
The DSM‑5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) includes ”Substance Use Disorder” as a recognized medical diagnosis. In short, it is characterized by criteria such as:
- Taking a substance in larger amounts or longer than intended
- Unsuccessful attempts to cut back
- Craving
- Failing to meet work or personal obligations
- Withdrawal symptoms
- Continuing use despite harm
If you meet two or three of these criteria, you have a mild substance abuse disorder or SUD. Six or more criteria means a severe SUD. Because SUD affects your ability to function at work, it can potentially qualify as a disability condition for STD or LTD insurance.
How Relevant Are Substance Abuse Disorders to Disability Claims?
While not every victim of substance abuse will file disability claims, addiction is undeniably widespread. So are its disabling effects.
Certain professions—especially high‑stress jobs such as legal, medical, finance, and consulting—report higher rates of substance misuse and alcohol dependency. Recognizing that addiction can affect any worker is important when you believe your job performance or ability to work is impacted.
Can I Get Short‑Term Disability for Alcoholism or Substance Abuse?
Yes, in many cases. But as with all disability insurance claims, the terms depend heavily on your specific policy.
Short‑term disability insurance is designed to provide income replacement when you cannot work for a limited time due to illness or injury. Some STD policies explicitly exclude disabilities caused solely by substance use or self‑inflicted conditions. Others may cover them, but with strict conditions.
To qualify:
- You must show that your substance use disorder prevents you from performing the material duties of your job.
- You must have a medical diagnosis and be receiving treatment from qualified professionals.
- Your policy will define what “disabled” means: either inability to perform your own occupation or inability to perform any occupation.
- You must comply with your treatment program and any insurer requirements.
If your alcoholism or drug use has escalated to the point where you cannot meet your job’s responsibilities and you are undergoing treatment, you may have a valid STD claim.
RELATED: Can Short-Term Disability Be Denied for Mental Health?
Does Being in Rehab or Outpatient Therapy Qualify Toward Receiving Disability Benefits?
If you’re enrolled in an inpatient or outpatient treatment program and you’re unable to work because of the severity of your condition, the STD insurer may treat that as a disability. But documentation is key. You’ll need records showing your diagnosis, your impairment in work performance, and your prescribed treatment plan.
Can Long‑Term Disability (LTD) Cover Alcoholism or Substance Abuse?
Sometimes. But there are far more limitations, exclusions, and complexities.
Long‑term disability insurance is designed for extended absences from work (often many months or years). Unlike STD, LTD claims carry higher stakes for insurers and typically face tougher scrutiny.
Key Differences and Important Issues for SUD Claims:
- Waiting/elimination period: Most LTD policies require you to be disabled for a certain period (often 90 to 365 days) before benefits begin. That means you may need to rely on STD or other income until LTD kicks in.
- Definition of disability: Many LTD plans use a more restrictive definition such as “any occupation” after a certain period. If you can do some other work even if you cannot do your prior job, the insurer may deny benefits.
- Exclusions and benefit limits: Some LTD policies impose special rules for substance use disorders. For instance, they may limit benefit payments for a defined period (commonly two years) if your primary disability is addiction or alcoholism. Others may exclude benefits altogether for substance‑related disabilities unless other conditions also apply.
- Proving treatment and compliance: Insurers will examine whether you’ve complied with your treatment program, whether your condition is stabilized, and whether you still meet the policy’s “material duties” standard. Relapses or gaps in treatment may be used against you.
- Self‑inflicted or pre‑existing clauses: Some policies treat addiction as self‑inflicted or exclude coverage if your SUD predates the policy or arises from substance use during non‑prescribed or illegal activities.
Does Having an SUD Automatically Disqualify me from LTD Benefits?
No, but you must meet your policy’s terms and show how your condition renders you unable to work. The existence of a substance use disorder itself is not fatal to every LTD claim, but many insurers will use it to challenge your claim.
Are There Typical Benefit Caps for SUD‑based LTD claims?
Yes. For example, an LTD policy might limit benefits to two years if the disability is due to an SUD and then require you to transition to another benefit or lose coverage. Be sure to review the “policy benefit maximums” or “condition‐specific limitations” sections of your policy.
What Should I Ask My Policy and Claim Processor About Disability for Alcoholism or Substance Abuse?
- Does the policy exclude disabilities caused solely by substance abuse or addiction?
- If not excluded, is there a separate benefit period or cap for SUD claims?
- What definition of “disability” does the policy use (own occupation vs. any occupation)?
- Are there elimination/waiting periods before LTD benefits begin?
- What documentation or treatment compliance is required?
- Does the plan contain a pre‑existing condition clause that applies to my SUD?
- Are there offsets for other benefits (medical, SS, workers’ comp) that might reduce LTD payments?
- Will my employer‑sponsored plan be governed by Employee Retirement Income Security Act of 1974 (ERISA) rules, which may limit legal options?
The answers to these questions can make a big difference in whether you pursue STD or LTD and how you approach the claim.
When Should I Contact a Disability Attorney Regarding my Alcoholism or Substance Abuse Disability Claim?
The sooner the better. Here are key moments when you should contact a disability attorney, such as those at Bryant Legal Group:
- Before you file an STD or LTD claim for substance abuse, so an attorney can review your policy and strategy.
- If your insurer denies or delays your STD or LTD claim.
- If you believe your assertion of disability is being challenged because of your SUD diagnosis.
- If you receive communications from the insurer saying your substance use is excluded or requiring you to meet additional hurdles.
- If you’re unsure whether your coverage is employer‑sponsored (ERISA) or individually underwritten, and what that means for your rights.
An experienced disability insurance attorney will clarify your policy, help you gather the necessary documentation, review how substance use is treated under your plan, and advise you of your legal options.
NOTE: Bryant Legal Group focuses on insurance law and disability claims. While we do not handle standalone SSDI claims, we guide those seeking STD or LTD insurance benefits.
How Can I Strengthen My Disability Claim for Substance Abuse?
- Obtain a clear diagnosis and treatment plan. Your medical provider (addiction specialist, psychiatrist, psychologist) should document your SUD diagnosis, treatment timeline, functional limitations, and prognosis.
- Demonstrate work incapacity. Show how your substance use disorder—coupled with any medical and psychiatric consequences—prevents you from performing your job’s essential duties.
- Comply with treatment. Enroll in and attend inpatient or outpatient therapy programs, follow medication protocols, attend support groups, and document your compliance. Non‑compliance is often used by insurers to deny claims.
- Create a functional journal. Track how your symptoms impact your functioning and job performance. Include dates, treatment progress, relapses, and the resulting impact.
- Avoid information gaps. Keep all records of treatment, communication with insurers, employment changes, and your daily limitations.
- Get legal review early. An attorney can assess your policy, interpret exclusionary clauses, identify deadlines, and coordinate expert reports if needed.
What Are Some Common Insurer Strategies in Substance Abuse Claims?
Insurers are well aware of the complexities around claims involving substance use or addiction. Some common tactics include:
- Asserting your addiction is a pre‑existing condition and therefore excluded.
- Arguing your disability is “self‑inflicted” and as a result excluded under the policy.
- Claiming you are non‑compliant with treatment because of relapse or missed appointments.
- Contending that you are capable of some work and therefore fail an “any occupation” standard.
- Minimizing the effects of your SUD by focusing on other conditions or claiming they are not disabling.
- Relying on independent medical exams (IMEs) biased toward denying the claim.
Because these claims involve both medical and behavioral issues, having legal representation that understands both the insurance contract and the medical side is critical.
RELATED: What is a Bad Faith Insurance Claim?
We Can Help You Seek Disability for Substance Abuse or Alcoholism
If you are struggling with alcoholism or a substance use disorder, and your condition has impaired your ability to work, you may have more financial protections than you realize. Yes, STD or LTD insurance may provide support, but the policies often contain complex definitions, exclusions, and limitations—especially for substance‑related disabilities.
At Bryant Legal Group, our disability insurance attorneys are dedicated to helping policyholders understand their rights, evaluate their policies, build claims, and confront insurers.
If you are facing uncertainty about filing a claim, believe your insurer is treating you unfairly, or want to review your coverage before proceeding, please contact us for a confidential consultation. We’ll review your policy, examine the facts of your case, explain your rights, and help you decide the best path forward.
Call us today or complete our contact form to get started. You don’t have to navigate this alone.
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.