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Long-Term Disability Claims for Post-Traumatic Stress Disorder

When you hear the term Post-Traumatic Stress Disorder (PTSD) you may think about a condition that affects war veterans or people who work in emergency services or those who have suffered abuse, disasters or major illnesses and accidents.  However, the condition can also result from highly personal traumatic events like losing a job or a business, divorce, failing to achieve a goal, loss of a loved one, seeing, hearing or reading about of a death or other traumatic event, personal injury, childhood trauma or any other life-altering experience.  PTSD can affect people of any age, culture or gender and that the condition may or may not rear its ugly head until months or years after a traumatic event.  

While proving to an insurance company that you are unable to work due to any mental health-related condition can be challenging, if you are suffering from PTSD, you are likely to encounter some unique challenges, particularly when you have failed to prove your initial claim for LTD benefits and you are considering how to deal with the denial of your LTD claim; either by way of appeal or litigation

What is Post-Traumatic Stress Disorder (PTSD)?

According to the Centre for Addiction and Mental Health (CAMH), Post-traumatic stress disorder (PTSD) is a natural emotional response to frightening or dangerous experiences that involve actual or threatened serious harm to oneself or others. For example, PTSD may develop as a response to traumatic life events, such as car crashes, fires, bombings, rape, torture or seeing a family member, friend or other person harmed or killed. Being involved in a natural disaster, such as a hurricane, flood or earthquake, can also lead to PTSD. 

Signs & Symptoms of Post-Traumatic Stress Disorder (PTSD)

According to CAMH, PTSD will usually appear within three months of the traumatic event, but sometimes symptoms may not appear until many years later.  In many of the PTSD LTD benefit cases we have had, the condition and symptoms of PTSD have arisen long after the traumatic event.  This may be partly the reason these LTD claims were denied. 

Whether the condition has been continuous or whether it has arisen much later, the symptoms of PTSD can be debilitating and affect every area of a person’s life and functioning.

In terms of symptoms, CAMH provides the following list of common symptoms:

  • re-experiencing the traumatic event over and over
  • having recurring nightmares
  • experiencing unwanted, disturbing memories of the event
  • acting or feeling as if the event is happening again
  • feeling upset when reminded of the event
  • staying away from activities, places or people that are reminders of the traumatic experience
  • avoiding friends and family
  • losing interest in activities that used to be enjoyable
  • experiencing difficulty having loving feelings
  • being unable to feel pleasure
  • constantly worrying
  • having a hard time concentrating
  • getting angry easily
  • having trouble falling asleep or staying asleep
  • fearing harm from others
  • experiencing sudden attacks of dizziness, fast heartbeat or shortness of breath
  • suicidal thoughts
  • symptoms of anxiety and panic attacks
  • having fears of dying.

It is not difficult to imagine how these symptoms would have a serious and debilitating effect on a person’s functioning; including with respect to their ability to work. Unfortunately, LTD insurance companies are not in the business of “imagining” how a person with PTSD is prevented from working.  Rather, insurance companies are in the business of looking for “objective” findings as evidence of disability.  Based on the denied claims we see, insurance companies seem to continue to find it difficult to assess the severity of PTSD symptoms and determine how those symptoms prevent a person from performing the duties of their own or any occupation (which is typically the test of disability, depending on the wording of the insurance policy).

Post-Traumatic Stress Disorder (PTSD) Causing Disability

For some people, the thoughts or memories of past traumatic events can have serious implications for their health and functioning in their day-to-day lives, long after the danger or threat has passed. Without proper treatment and support, PTSD can cause long-term disability.  Even with proper treatment, the road to recovery can be long.

The risk of PTSD, the severity of symptoms and the recovery period will depend on a number of factors, including: 

  • having a history of mental health or substance use problems;
  • feeling helplessness or extreme fear;
  • having appropriate treatment and a support system after the traumatic event
  • feeling guilt, shame or responsibility for the event or its outcome
  • experiencing additional stress after the event, which may include, the loss of a loved one, other pain and/or injury, loss of a job or home

In addition to the above list, in our experience representing clients with PTSD, the denial of a claim for LTD benefits by an insurance company can also have devastating implications for those already struggling with symptoms of PTSD.  A denial of LTD benefits can serve to prolong the recovery period by re-triggering the initial trauma and by extinguishing funds that would otherwise be available for treatment.  An LTD denial also results in serious financial distress caused by not having an income.

Long-Term Disability Claims Due to Post-Traumatic Stress Disorder (PTSD)

Nearly all of our clients struggle with some degree of mental health-related illness. For many, their mental health condition is the sole cause of disability and for others, it may be a condition secondary to their physical disability.  Post-Traumatic Stress Disorder (PTSD) is one of those conditions that our clients may have as either a primary disabling condition or as a secondary cause of disability.  In other words, sometimes our clients are disabled solely as a result of PTSD and sometimes our clients with PTSD are also struggling to work due to a number of other conditions, which we’ve found will commonly include, chronic fatigue and chronic pain conditions.

Whether it is the main cause of disability or whether it is one of a number of other reasons a person is unable to work, we have noticed in recent years that PTSD has become a much more common diagnosis in the denied LTD claims that we see in our law practice. It is unclear to us whether this increase in the number of clients we see suffering from PTSD is due to better or more accurate diagnoses and assessment of the condition by health professionals or whether PTSD has become a more prevalent or more widely accepted mental illness in our society, generally.  Either way, an increase in these types of LTD cases in our law practice suggests to us that insurance companies are continuing to struggle to assess and approve LTD claims for PTSD.

Diagnosis & Treatment of Post-Traumatic Stress Disorder (PTSD)

While some people can and do recover from PTSD quickly (often within six months or so) and never need to make an LTD claim, others take much longer to recover and regain their functioning.  Since LTD insurance companies rely mostly on objective measures and also medical guidelines for expected recovery times, and since PTSD can manifest in different symptoms and recovery times may differ between claimants, it is difficult for insurance companies to assess whether a person’s claim is legitimate or whether the person is actually well enough to work and the claim should be denied. 

Diagnosing and determining the severity of symptoms of PTSD, as with all other so-called “invisible conditions” (like other mental health conditions, chronic fatigue and chronic pain conditions), is based on subjective findings.  This means that the treatment providers who diagnose and treat PTSD must rely on the patient’s self-reported symptoms to make the diagnosis of PTSD; to gauge the severity of symptoms; to determine appropriate treatment; and, upon which to base their opinions regarding the person’s functioning and their ability to return to work. (For more information about LTD claims for “invisible conditions”, please refer to our previous article, “Struggling to be Seen & Believed: Making an LTD Claim for an Invisible Condition”). 

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