Archives for March 2020

Can I Get SSDI Benefits For Opioid Addiction From Prescribed Medication?

Can I get SSDI benefits for Opioid Addiction from prescribed medication?

Opioid addiction have become one of US’s biggest drug concerns. This type of drug can be either synthetically produced or derived from opium. Most commonly used as pain relief, they are effective, but also have the potential to become addictive in some patients.

The term “opioids” can include anything from the illicit heroin to synthetic versions like fentanyl (a very tiny amount can be instantly fatal) as well as prescription pain relievers such as morphine, codeine, oxycodone (also known as OxyContin), hydrocodone (also known as Vicodin) and a number of others.

Opioids are great at relieving chronic pain, but patients can’t just stop taking them or they quickly experience withdrawal. The unfortunate nature of their effectiveness is also the pathway to addiction.

More than 40% of individuals on Social Security Disability are prescribed opioids for pain relief. Many are on very high doses for musculoskeletal disorders, which comprised 94% of chronic users. Depression among opioid users is about 38%. But if you find yourself unable to live without them, even when properly prescribed by a doctor, you could be addicted.

What Is An Opioid?

The term “opioid” describes a class of drugs that bind to the body’s opioid receptors. Morphine and other opioids are frequently prescribed for pain.

Opioids can also offer a feeling of euphoria, leading to the continued use and eventual mis-use of prescriptions. This is how many people become addicted in a short period of time.

Prescription opioid addiction is a particularly difficult situation, because the patient is frequently in a certain degree of pain. As with any addictive drug, the patient may find themselves increasing the amount of medication to get the same degree of relief from the drug. Eventually, they can’t stop taking the drug, because they may experience severe withdrawal symptoms as well as the return of physical pain. In some cases, patients may turn to more illegal forms of opioid like heroin if they are unable to acquire additional prescriptions.

Disability For Opioid Addiction

Social Security’s rules for disability due to addiction are very straightforward, and the short answer is usually “no.” But it’s not that simple.

Social Security doesn’t consider a drug addiction of any kind a disabling condition, even if it prevents someone from working. Only until it produces irreversible, permanent conditions does the Social Security Administration consider someone eligible for disability. All cases are reviewed in the same manner, no matter how the disability occurred.

SSA does not consider an addiction to properly prescribed prescription drugs to need a drug addiction or alcoholism determination (DAA.) However, SSA can take into consideration the disabling effects and limitations caused by a prescription that is used to treat a condition that a claimant is applying for. The side effects of a medication should be included when describing the seriousness of a patient’s condition.

In Social Security Ruling 13-2p, the SSA clarifies this point by stating that a DAA determination is “not to be applied” in cases of “addiction to, or use of, prescription medications taken as prescribed, including methadone and narcotic pain medications.” This also means that any side effects of the prescription will be taken into account when considering if a claimant’s symptoms are severe enough to be disabling.

What SSA Will Consider

The SSA previously had a listing for drug addiction, but as of 2018, that listing no longer exists. Impairments that result from a substance abuse addiction include:

  • Depression
  • Anxiety disorder
  • Personality disorder
  • Seizures
  • Brain damage (neurocognitive disorders)
  • Peripheral neuropathy
  • Gastritis
  • Pancreatitis

Of course, as with any condition, the SSA will require evidence of your condition, including diagnostic reports, your treating physicians’ contact information, details of any hospitalization, and a list of your medications and associated side effects.

While chronic misuse of opioids such as codeine may not produce permanent organ damage, improvements in brain imaging offer evidence of abnormalities as a result of codeine. This may also apply to other forms of opioid narcotics.

Permanent limitations that result from opioid drug use may be considered disabling if they are to the degree that they are serious enough to rate.

Houston’s Opioid Addiction Attorney

Social Security Disability laws are complicated and complex. If you’ve been denied disability payments for drug addiction or other debilitating condition, call us immediately. We’re ready to help.

We’ve helped over 4,000 Houstonians get their disability benefits. The Herren Law Firm in Houston, TX can assist with your application, appeals and records gathering to prove your case, and win your claim. Contact us today at 713-682-8194 (or user our online contact form) to schedule your free consultation. There’s no obligation, and no up-front fees, and we only collect a fee if we win your case.

 

Reasons For Long Term Disability Denial Of Claim

After paying premiums for several years, you expect that when you have to file a claim for long-term disability your insurance company will take care of you. But as many policyholders have discovered, that’s not always the case. You’ve had doctor visits, testing, treatments, therapy, and filled out a ream of paperwork that they’ve asked for, only to see your claim denied. So what’s going on here?

Reasons For Long Term Disability Denial Of Claim

Insurance companies are in business to make money and will deny your claims any way they can. These are some of the reasons your claim may have been denied.

They’re Watching You

Insurance companies regularly conduct video surveillance of individuals who file an LTD claim when they say they’re disabled and can’t work. Why? To prevent obvious insurance fraud, particularly by individuals who claim they can’t work because of an injury, but they’re publicly engaged in activities that they shouldn’t be.

Surveillance can be both long-range video and social media investigation. Even with your account set to “private,” it’s highly possible your vacation pictures and other “action shots” can be visible to people who you never intended. It’s always advisable to set your posts to “friends only,” but you should also be aware of who is following you and who you accept friend/follow requests from. Additionally, investigators may be able to access your account by demanding your passwords.

For instance, if you’ve filed a claim for a back injury that prevents you from working, and you post pictures of yourself surfing in Maui, that’s a clear indication that you’re not injured. Of course, if that picture is five years old, an investigator may not realize that, even if you date it.

Best bet: limit your social media postings, or deactivate or delete them until your case is decided.

Not Enough Medical Evidence

Any kind of insurance claim needs sufficient medical evidence to support it. Evidence is key to supporting your claim and showing that you are, indeed, disabled.

  • Consistent medical treatment for your condition(s). Your insurer expects that you are receiving consistent and regular medical care for the condition you are claiming. If you aren’t receiving regular medical care, the insurer will interpret this as your condition isn’t serious. Physical illnesses will include physician visits, as well as any required testing such as X-Rays and MRIs. If your claim includes mental illness such as depression, you should be seeing a mental health provider (such as a psychologist or psychiatrist) on a monthly basis or better.
  • A doctor’s statement detailing your medical condition and how your disability limits your ability to work. Don’t rely on the insurance company’s forms—they are designed for you to respond in a way that will ensure your claim is denied. Should your doctor deny you support for your disability, find another one who will help.
  • Absent medical records that are essential to proving your claim. If the insurance company hasn’t requested all relevant records, request a list of all the records they have already requested an a list of what they’ve received. Then insist that the insurer request all the records on the list. You may have to be persistent until they have all of your medical records.

Missed Deadlines

Insurance companies are notorious for deadlines, and even one day can end your claim. Make sure you understand their deadlines for both applications and appeals.

You Don’t Meet Their Definition Of “Disabled”

As ridiculous as this may sound, most policies have strict definitions of what “disabled” actually means.

One of the biggest sticking points is “own occupation” and “any occupation” clauses in the policy.

Own occupation” indicates that your disability prevents you from fulfilling the requirements of your current occupation. “Any occupation” means that you are unable to fulfill the requirements of any occupations. Some policies begin as “own occupation” but transition to “any occupation” after 24 months.

Additionally, pre-existing conditions and medical conditions related to current or prior substance abuse tend to be excluded. Mental conditions and those that are based primarily on self-reported symptoms, such as fibromyalgia and chronic fatigue syndrome, may be limited to 24 months of benefits after approval.

Your Houston LTD Disability Attorney

When applying for long-term disability it’s important to follow your insurer’s instructions to the letter. They’re not interested in helping you and your claim, but there’s someone who can help.  The Herren Law Firm can help you with your application, appeals and help you through the process so you can get the benefits you need. Contact us today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation, and no up-front fees, because we will only collect if we win your case.

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