Adherence to treatment plans critical in addiction-related LTD claims

Adherence to treatment plans critical in addiction-related LTD claims

By Nainesh Kotak

Following the advice of your doctor and other treatment providers is critical for long-term disability (LTD) claimants with serious addiction issues.

Alcohol and drug abuse spring most easily to mind when people think of addiction, and problematic use of these substances features commonly in LTD claims – but not exclusively.

Behavioural disorders such as compulsive gambling, shopping and other non-substance addictions can also lead indirectly to a person’s inability to work, thanks to the mental distress and depression that often accompany these problems.

And the prominence of addictions of all kinds is only likely to grow in the LTD field over the coming years as the fallout from the Covid-19 pandemic continues.

Canadians using more cannabis

Health Canada’s annual cannabis survey found that 29 per cent of users said they had boosted their consumption of the drug since the onset of the pandemic, with most putting their higher use down to the boredom, anxiety and stress that came with the disease and its related restrictions.

Meanwhile, the U.S.-based Centers for Disease Control and Prevention reports that as many as 30 per cent of cannabis users may be addicted to the drug.

Canadians’ use of alcohol also hit the headlines recently when the Canadian Centre on Substance Use and Addiction urged the country to “rethink the way we drink” after fresh research led it to conclude that even small quantities of alcohol can be bad for your health.

Whatever the source and specifics of an individual worker’s debilitating addiction, it’s important for them to follow the advice of their medical professionals by adhering to treatment plans and attending any rehabilitative programs designed to aid their recovery.

This is not only for the good of their health, but also for the benefit of their LTD claim, since a failure to do so will most likely result in a denial or termination of benefits.

Claimants have a duty to mitigate damages

Courts have consistently recognized that long-term disability claimants have a common-law duty to mitigate their damages, but the requirement for insureds to abide by the recommendations of their treating practitioners is usually also spelled out explicitly in contractual provisions that form part of their individual and group LTD policies.

Unfortunately, disabled workers dealing with addictions cannot expect any compassion or sympathy from their insurers. Even strict adherence to medical advice is no guarantee that benefits will continue flowing uninterrupted, and many insured people end up having to fight their LTD providers as well as their substance abuse issues.

Stigma remains a major stumbling block

Despite societal progress, there remains significant stigma attached to addiction issues and other disorders with a psychological element to them, especially in the insurance industry.

As a result, claimants with mental health are more susceptible to denials and terminations, particularly after 24 months of benefits, when the test for continued coverage becomes stricter.

However, many of these adverse decisions by insurers are ripe for legal challenge, and we are proud to advocate strongly on behalf of people suffering from addiction.


We understand that being denied short-term disability or long-term disability benefits can be devastating. Your time to fight your disability insurance company is limited. Please do not delay in calling a short- and long-term disability claim lawyer at Kotak Personal Injury Law. We have successfully sued numerous disability insurance companies including Manulife, Sunlife, Desjardins, Cigna, Great-West Life, Equitable Life, Empire Life, London Life, Blue Cross, AIG, SSQ, RBC, Industrial Alliance, Canada Life, Fenchurch, OTIP, Teachers Life and more.

Call your trusted long-term disability lawyers at 1-888-GOKOTAK (Toll Free for all of Canada), or (416) 816-1500 (Local Number for Ontario Residents), (403) 319-0071, (587) 414-1010 (Local Numbers for Alberta Residents). Our consultation is free, and we don’t get paid until you do. We represent disabled people throughout Ontario and Alberta, including Toronto, Mississauga, Brampton, Milton, Georgetown, Orangeville, Oakville, Burlington, Hamilton, St.Catharines, Niagara Falls, Stoney Creek, Kitchener/Waterloo, Cambridge, London, Windsor, Markham, Pickering, Oshawa, Peterborough, Keswick, Kingston, Ottawa, Banff, Brooks, Calgary, Edmonton, Fort McMurray, Grande Prairie, Jasper, Lake Louise, Lethbridge, Medicine Hat, Red Deer, Saint Albert and other locations.