Is Alcohol Rehab Covered by Short Term Disability

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When alcohol abuse hinders or eliminates your ability to work, you could turn to your short-term disability and long-term disability policies for help. But you may find yourself battling with your insurance company rather than focusing on your recovery. 

According to the Substance Abuse and Mental Health Services Administration, about 19.7 million people struggle due to substance abuse, including illicit drugs, prescription medications, and alcohol addiction. 

Alcohol abuse negatively impacts every demographic, economic, and social group. 

Once substance eliminates or limits someone’s ability to work, they turn their policies in short- and long-term disability for help.

The problem here is that they often battle their insurance company rather than focusing on the recovery process. 

In this article, you will discover whether private alcohol rehab clinics are covered by short-term disability or not. 

FAQ 

Will my short-term disability cover my substance abuse treatment? 

Yes, if you proved that your addiction is diagnosed as a temporary disability and meets the substance addiction treatment criteria.

You also need to provide a clear medical diagnosis with documentation from licensed healthcare providers. 

Will insurance companies deny substance abuse claims? 

Yes, if an insurance company sees that substance abuse is controllable and treatable.

The insurance company also denies the claims if the substance addiction is psychological symptoms (manifestation of bipolar disorder, schizophrenia, or depression) and not a physical condition. 

How can I manage my income while I rehabilitation?  

Even if you are under a rehabilitation program you can still manage your income.

You can take FMLA leaves to get 12 weeks of unpaid medical leave or short-term disability to get assistance with the medical bills and living expenses while in rehab. 

Alcohol Rehab and Short-Term Disability  

short term disability  and alcohol rehab stats

About 10% of adult qualify for substance use, while the majority never gets drug and alcohol abuse treatment.

Professionals who experience high stress levels at work are also high in substance use. 

According to the 2017 Hazelden Betty Ford Foundation survey, approximately 15% of surgeons have a history of unhealthy drinking.

Then, about 36.4% of lawyers reported harmful alcohol consumption. 

Without proper substance abuse treatment, dependence on the substance will take place. It will lead to life-changing losses.

That is why they turn to their short disability insurance policy to get financial stability while focusing on their sobriety and health. 

Healthcare insurance covers some or all of the outpatient or inpatient substance abuse treatment.

However, the healthcare plan does not offset the lost income during the rehab period. Professionals turn to their short- or long-term disability insurance policies for financial support. 

Does Alcohol Rehab Qualify for Short Term Disability  

Short-term disability insurance provides monthly benefits if someone cannot work because of a chronic condition, illness, or injury.

Some policies do not include claims involving substance addiction recovery, while other disability insurance policies covered the disabilities because of substance addiction. 

Someone has to prove that their substance addiction is disabling to qualify for the disability benefits. 

The disability is defined in two ways depending on the policy’s terms and conditions: 

  • The substance addiction disorder prevents someone from doing the actual job. 
  • Someone cannot perform any full-time work because of drug and alcohol use and other medical conditions. 

If people qualify, the insurance company pays the monthly benefit and participates in addiction rehabilitation and therapy.

However, they are required to substantiate their claims and provide a clear medical diagnosis and documentation from the licensed therapist, psychologist, or doctor that details their struggles with substance dependence or addiction. 

Meanwhile, the insurance company does not pay the disability benefits of the employee if they only claim that they are struggling with substance addiction.

They have to prove that they are undergoing alcohol treatment with a healthcare professional. 

Reasons Why Insurance Companies Deny Substance Abuse Claims  

Even if the policy comes with broad benefits for the substance use claims, it’s expected that insurance companies will go against paying the benefits.

Below are the common reasons why these companies deny the claims for substance use: 

  • Deciding that someone is non-compliant when he relapses; 
  • Arguing that someone’s disability is self-inflicted; 
  • Minimizing someone’s other conditions, particularly the physical abilities; 
  • Claiming that someone’s drug use is a pre-existing condition.

If someone wants to counter the above arguments, he needs help from a professional and experienced disability lawyer with understanding and can interpret the short- or long-term disability policies.

why do insurance companies deny alcohol rehab claims

The lawyer also helps in evaluating drug use claims and analysing the complex medical history. 

Can Employees Lose Job If the Employers Know About the Substance Use and Treatment  

If job performance is being affected by drinking or using an illegal drug, the employer can fire him.

They have to prove that the employee’s performance quality is poor or lacks what they expect. 

When an employee gets rehab before the employer takes disciplinary action, they cannot fire them due to poor quality of work or past mistakes.

However, if the substance dependence or addiction causes issues at work and if it continues, it leads to getting fired. 

If the employee gets fired, he has no income resulting in losing everything, from the home, car, and financial support to a family member. 

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Can Employers Fire Employees While Getting Substance Abuse Treatment 

Illegal drugs use is already a good reason for employees to fire their employers, but it still depends on the organization.

If an employee is not actively using the substance, the employer has an accommodative policy to the detainment after alcohol or drug treatment. 

In the US, for instance, the employees have 12 weeks of leave every 12 months (either paid or unpaid leave) to treat the substance dependency or drug addiction, constraining them from working productively according to the Family and Medical Leave Act (FMLA).

The program includes going to rehab with no valid reason, like poor work ethic because of drugs or alcohol addiction. 

The medical leave act FMLA is a US federal law covering employers with 50 or more employees and providing employees paid or unpaid and job-protected leave for family and skilful family reasoning and other reasonable accommodations.

Family and medical qualifications include fostering a child, pregnancy, adoption, family military leave, and family or personal illness. 

FMLA leave is only taken for substance use treatment if provided by a healthcare service referred by a healthcare provider.

Under Family and Medical Leave, employees do not qualify if the leave of absence is because of alcohol or drugs addiction. 

Besides the FMLA leave, there is another law called the Americans with Disabilities Act (ADA). This act protects employees against discrimination due to disability.

Under ADA, it defines the disability qualifications. Individuals struggling with drugs or alcohol are considered to have a disability. 

If the job performance is affecting due to drinking or using drugs, the employer has the right to fire the employee.

ADA protects individuals that have a history related to drug use but are under rehab. ADA also protects individuals that are no longer attending treatment.

The employer has the right to conduct a drug test if necessary. 

Does Short-Term Disability Cover Mental Health  

does short term disability cover mental health 

The disability coverage varies by type of policy: individual, group, and state-based.

It also varies by reason, including drug or alcohol rehabilitation, alcohol or drug addiction, stress, anxiety, and depression. 

An individual policy has the most restrictive benefits, and a group plan is more lenient. Then, a state program falls somewhere in the middle.

That is why people have to terms and conditions in the policy to ensure they get the desired benefits. 

A private disability insurance policy does not cover behavioural health issues, such as schizophrenia, nervous breakdowns, eating disorders, bipolar disorder, depression, anxiety, and other mental illness. 

A short-term disability claim denial due to depression and anxiety is common for individuals with private coverage.

Private policies come in legal language that excludes benefits for mental health problems.

Since depression and anxiety fit the mood disorder category, the denial for the claim based on the reason alone is expected. 

On the bright side, it is still possible to get disability approval for depression and anxiety under two scenarios.

Individuals with private coverage need to have a related biological disorder, while those with state or group plans require more leeway. 

How to Pay Bills During the Rehabilitation Program  

If someone’s goal is to pay the bills with funds, several options are available, including: 

Prepayment  

People can find companies that accept funds in advance for 1-12 months without asking any questions.

They may be able to find lenders that charge fines unless they pay off the whole bill in advance based on the agreed credit terms. 

Auto Payment  

Banks offering auto-bill payment are also available. People pay the bills via an online portal.

These banks enable them to send auto payments to individuals on a recurring basis.

However, they have to call or visit the bank to activate the services if they are not set up, particularly if they plan to use it to pay debts and landlords to individuals or small companies. 

Asking A Family Member 

A family member is another option for paying the bills. They can help in taking care of the bills while someone is on rehabilitation. 

Conclusion  

An extensive substance rehab process makes someone feel normal enough and go back to a normal lifestyle.

Once they left their drug or alcohol addiction behind, they have a better chance of re-entering the workplace and live the way they used to be.

There is pressure in daily life routines, at work and home, but substance addiction does not solve it.

So, if you are having a hard time, do hesitate to seek help and have substance treatment and recovery to have a normal life once again. 

Do not let addiction ruin your life and lose your job. If you think it is time to take advantage of a rehab program, do not think twice.

Plus, ensure to get familiar with your disability policy or know if it will cover your current situation or not. Feel free to ask for legal help so that you can better understand your insurance policy.

Do not forget that your loved ones are also there for you, from start to finish of the rehab. Keep in mind that there is no wrong in seeking out treatment. 

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About the author

Peter Szczepanski

Pete has been on the GPhC register for 29 years. He holds a Clinical Diploma in Advanced Clinical Practice and he is a Clinical Lead in Alcohol and Substance Misuse for Abbeycare Gloucester and works as the Clinical Lead in Alcohol and Substance Use in Worcestershire. To read more about Pete visit his LinkedIn profile.