If you suffer from chronic pain or another disabling condition, you probably take medication to manage your symptoms. Medications often come with side effects, including drowsiness, dizziness, confusion, and memory loss. Those side effects can be just as impairing on your ability to work as the underlying disease, though obtaining disability benefits due to medication side effects is challenging. Although courts recognize the need to consider medication side effects when determining disability, many long term disability plan administrators still ignore those side effects in rendering their disability determinations. This article will address some of the recent case law and offer tips on how to prove disability due to medication side effects.
Table of Contents
Court Confirms that Medication Side Effects Can Support a Disability Insurance Claim
Courts have consistently ruled that a disability plan administrator must consider medication side effects in rendering a disability determination, and that failure to do so is grounds for reversal. The recent decision in Quezada v. Lincoln Life Assurance Co. of Boston, C 20-07515 WHA, 2021 WL 4079161, at *10 (N.D. Cal. Sept. 8, 2021) provides a case in point. Mr. Quezada had to leave his position as a warehouse worker due to low back and hip pain. He took Norco, a narcotic pain medication, up to four times daily to manage his pain. The district court ruled that the disability plan administrator, Lincoln Life Assurance Company of Boston, abused its discretion by failing to address the mental effects of his pain medication, among other things.
The Quezada decision is consistent with a larger body of case law affirming that disability plan administrators may not disregard medication side effects in deciding whether someone can work. See, for example:
- Smith v. Cont’l Cas. Co., 450 F.3d 253, 265 (6th Cir. 2006) (overturning denial of disability benefits where disability plan administrator failed to adequately consider the number and nature of the medications the claimant was taking);
- Torres v. UNUM Life Ins. Co. of Am.,405 F.3d 670, 681 (8th Cir. 2005) (denial of disability benefits was unreasonable where insurer failed to consider impact of claimant’s heart medication on his ability to concentrate).
Medication side effects are of particular importance if they pose a safety risk. For instance, narcotic pain medicine is known to cause drowsiness that interferes with the ability to drive or operate machinery. Thus, if driving or operating machinery are material job duties, then the need for narcotic pain medication would render the claimant disabled. That was the conclusion of the courts in McAllister v. Life Ins. Co. of N. Am., 4:08CV03619-WRW, 2009 WL 1286328, at *4 (E.D. Ark. May 7, 2009) (ruling claimant was disabled from his former occupation as a mold-maker due to his use of morphine) and Adams v. Prudential Ins. Co. of Am., 280 F. Supp. 2d 731 (N.D. Ohio 2003) (overturning denial of disability benefits and awarding attorney’s fees to claimant where Prudential ignored impact of heavy medication regimen on his ability to drive).
Side-Effects Are Proof of Disability
Medication side effects are important in disability benefits cases not only because of their impact on a person’s ability to work, but also because they reinforce the severity of the claimant’s underlying medical condition. A person does not voluntarily subject themselves to medication side effects that are worse than the underlying disease. Thus, a claimant’s willingness to tolerate unpleasant side effects reinforces his or her credibility and the severity of his or her underlying injury or illness.
Judge Richard Posner put it best in Carradine v. Barnhart,360 F.3d 751, 755 (7th Cir. 2004) when he wrote:
What is significant is the improbability that [the claimant] would have undergone the pain-treatment procedures that she did, which included not only heavy doses of strong drugs such as Vicodin, Toradol, Demerol, and even morphine, but also the surgical implantation in her spine of a catheter and a spinal-cord stimulator, merely in order to strengthen the credibility of her complaints of pain and so increase her chances of obtaining disability benefits.
As Carradine illustrates, a lengthy treatment history and willingness to tolerate unpleasant medication side effects can reinforce a disability claimant’s credibility. Although Carradine involved a claim for Social Security disability benefits, it has been cited favorably in several long term disability cases as well. See, e.g., Maher v. Massachusetts Gen. Hosp. Long Term Disability Plan, 665 F.3d 289, 308 (1st Cir. 2011); Diaz v. Prudential Ins. Co. of Am., 499 F.3d 640, 646 (7th Cir. 2007).
Why Documentation Is So Important?
Medication side effects, much like pain and other symptoms, are “subjective,” in that they can be observed only by the patient. In contrast, “objective” evidence, such as laboratory test results and x-rays, are observable by the self and by others. Merely because something is “subjective” does not make it less valid; however, it does make it more susceptible to nit-picking by insurance companies.
For this reason, it is important that you discuss medication side effects with your doctors. Not only will doing so help to potentially identify alternative medications that you may tolerate better. It will also ensure that your medication side effects are properly documented for the purposes of your disability claim. A disability plan administrator is less likely to question your complaints of medication side effects if those complaints are well-documented in your medical records.
In addition, consider keeping a symptom diary that includes a discussion of medication side effects. That is particularly true if you suffer from migraine headaches, fibromyalgia, or other painful conditions that are highly variable and respond well to medication.
If your medication side effects are so severe that they impair your cognition, you may be tempted to undergo a neuropsychological evaluation, but proceed with caution. The medication side effects may interfere with your test performance such that the results are rendered invalid. For that reason, we generally do not recommend neuropsychological evaluation to substantiate cognitive impairment due to medication side effects, unless the evaluator is very experienced.
How Can a Disability Lawyer Help?
A disability lawyer can help you to prevail on your disability claim due to medication side effects. First, a lawyer can ensure that your medication side effects are adequately documented in your disability application and claim forms. Too often, medication side effects are overlooked by both the claimant and disability plan administrator in determining whether a claimant is disabled. Putting them front and center will ensure that they are not ignored.
Second, a disability benefits lawyer can review your medical records and offer advice on ways to improve documentation of side effects. If necessary, the lawyer can work with your doctor to craft a letter describing your side effects and detailing their impact on your ability to work. The lawyer can help your doctor translate your medication side effects into workplace restrictions and limitations, such as the inability to remember detailed instructions or maintain punctuality.
Finally, a disability lawyer can identify vocational resources, such as the U.S. Department of Labor Dictionary of Occupational Titles, to document how your medication side effects impact your ability to perform the materials duties of your past work. If, for example, your past work required the ability to drive or operate machinery, the lawyer can document and emphasize those requirements. Similarly, the lawyer can engage the services of a vocational expert to explain how the restrictions and limitations resulting from your medication side effects impact your ability to perform your past work or adapt to other work.
If you are disabled due to medication side effects and have been denied short term or long term disability benefits, or are considering applying for STD or LTD benefits, contact the attorneys at DeBofsky Law today for a free consultation.