Many people think that they will not be able to successfully claim a TPD benefit if the cause of their disability and work incapacity is drug and/or alcohol addiction. However, we have had a number of successful TPD and income protection claims for people who have stopped working due to addiction issues. The most important thing when making a claim involving drug and/or alcohol addiction is that you have doctor’s support. Also, it’s best if a specialist is involved in your treatment and supports your claim.
Common issues on disability insurance claims for drug and alcohol addiction
The most common barrier to success on TPD claims for drug and alcohol addiction is getting the right treatment for your condition and medical support for the claim.
Many people that we assist with TPD claims simply cannot afford to see a doctor, psychologist or other medical professional for treatment on their claim on an ongoing basis; or they are not able to access the relevant service where they live.
Other times, the complexity of the ways that their illness impacts them means that it’s really hard to find the right doctors or other treaters. This issue is particularly problematic for people with addiction issues, particularly those in country/regional locations.
This lack of access can cause issues because it can lead to the fund or insurer deciding that:
- you are not under the care and attention or following the advice of a medical practitioner, which is often a requirement to successfully claim income protection and sometimes a requirement to successfully claim a TPD benefit;
- you have not reached maximum medical improvement (i.e. you can still get better with treatment) and are not totally and permanently disabled or not entitled to income protection on an ongoing basis;
- you are refusing medical treatment;
- your illness is a lifestyle choice (i.e. you choose to use drugs and/or alcohol), and your illness is not a real illness (Note: this attitude is not as common on insurance claims in recent times).
How we deal with issues in TPD claims involving drug and/or alcohol addiction
We are not able to recommend treatment options or otherwise become involved in your medical treatment.
However, we can say that it’s really important that you have medical support for your TPD or income protection claim. There is a strong likelihood that your claim will not be successful without the medical support of at least one treating doctor. Therefore, if you have never seen a doctor at all, we would struggle to help you with a claim. But if you are seeing a doctor (or have done so in the past), we can usually help you by working with you or with your doctor directly to get support for your claim.
If we have the medical support but more support is needed, we can consider options to get help on the claim from a consultant (e.g., a medicolegal psychiatrist) or other medicolegal expert (e.g. a Vocational Assessor).
Similarly, these types of independent assessments can be really useful to help deal with assertions by insurers (or their medicolegal experts) that you need further treatment of a particular type or that, with further treatment now or in the past, you would be able to work.
Otherwise, where issues are raised on a TPD or income protection claim around drug and/or alcohol addiction (or other addictions that may cause you to stop working) not being a real illness or being a lifestyle choice, we can help you to get medical evidence regarding the underlying medical cause of your addiction to support your claim.
Get help from a TPD lawyer
TPD and income protection claims involving addiction can be complicated, but they are not impossible. It’s important to ensure you have the right supports around you to help you with your claim – this includes having a lawyer highly experienced in TPD claims. Call us for free advice about your unique circumstances. We’ve helped many people with similar issues achieve great results with their claims.
Contacting Berrill & Watson
📞 Melbourne: 03 9448 8048
📞 Brisbane: 07 3013 4300
📞 Anywhere else in Australia: 03 9448 8048
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