Post-traumatic stress disorder can be debilitating and prevent you from performing the essential duties of your occupation.  PTSD is a mental and cognitive condition that affects your brain and causes physical changes including a reduced size of the hippocampus. Due to this, many people with PTSD are unable to work because of flashbacks, reactions to triggers (such as military veteran throwing themselves to the ground when hearing a car backfire), difficulty with memory, empathy, concentration and focus, etc.

Unfortunately, many long-term insurance companies do not take post-traumatic stress disorder (PTSD) seriously.  Insurance companies regularly deny long-term disability benefits because they say it’s "all in your head," something you can simply "get over" or "snap out of."  They are wrong.  PTSD is caused by changes in the brain, not personality or lack of willpower. There is no shame in experiencing it, and there should be no stigma attached to it. 

Our experienced long-term disability lawyer will help you every step of the way.  We’ll review your denial letter for free and provide you with a strategy to move forward and get your benefits back.  Call our office today at 816-203-0143.  Let us navigate the next steps for you.

What is Post-Traumatic Stress Disorder?

ptsd in dictionaryPTSD can occur in some individuals after a traumatic event.  It is not limited to combat veterans, which is commonly what most people think of.  PTSD may result from a car crash, from being a victim of a crime, from witnessing a crime, from being involved in a natural disaster, from being in the hospital because of a medical condition, or anything that is traumatizing to a person.

You don't have to be in literal physical danger to get PTSD.  Someone can experience PTSD from the sudden death of a loved one or a traumatic event (such as physical or emotional abuse).

When PTSD develops, your brain essentially gets stuck in ‘fight or flight’ mode and is unable to self-regulate back to a normal state.  This fight or flight state is called hyper-vigilance and can cause symptoms that fall into four groups:

  • Re-experiencing. This is the classic flashback, or when you have anxiety or nightmares related to the traumatic event.
  • Avoidance. This is when you find yourself unable to return to the place or situation that caused the traumatic experience, or are trying to avoid thinking about it. Somebody who witnessed a crime in a shopping mall might not go back to that mall, or somebody who was in a car accident might stop driving, etc. You might also keep yourself busy or resort to addictive behavior to keep from thinking about it.
  • Arousal. This is being on edge, having insomnia, and the kind of startle reaction we were talking about at the start. Some people with PTSD may even have angry outbursts.
  • Cognitive. This means difficulty remembering things about the event, depression, feeling blame or guilt, having difficulty concentrating.

Most people with PTSD experience some form of the above symptoms after a traumatic event.  It's considered PTSD if it lasts for more than four weeks.

PTSD can often be resolved if treated early, so it is vital for anyone who has been involved in a traumatic event to be screened for PTSD by a therapist.  Early treatment, typically involving talk therapy and potentially medication if needed, can resolve symptoms and help you move on in your life.  However, this is not always the case. Sometimes PTSD symptoms can show up years after the triggering incident.

Why Some Insurance Companies Stop Paying After 2 Years For PTSD

Many insurance companies have a two-year limit on certain types of conditions.  Problems often occur at the two-year mark when the requirement to be disabled moves from "own occupation" to "any occupation."  This most commonly refers to drug abuse or alcohol abuse, but also often includes disabilities based on "nervous, mental, or psychological impairments."

The insurance company may require additional medical proof of your condition. They may also require a vocational report, and it's very likely that their hired vocational expert will find that you have the skills to perform plenty of jobs, even if your PTSD symptoms are making it impossible. These “hired guns” often give opinions biased towards the insurance company who is paying them.

Our experienced long-term disability attorney will read the fine print of your disability policy and develop a strategy to fight back these insurance tactics.  Being accused of dishonesty or faking it can be extremely painful for someone with PTSD who is truly suffering.  You can trust our attorney knows how to navigate these claims and get the disability benefits you deserve.

How to Appeal a Long-Term Disability Denial for PTSD

If your policy is covered by ERISA, then you do have the right to file an appeal after being denied. Filing a long-term disability denial appeal is your right, though it is a very complex legal process and certainly not something you should attempt on your own.

Our long-term disability attorney is trained in handling these appeals, including all the special rules and deadlines that apply.  We will review your policy and determine if the insurance company is calling your disability a "psychological impairment."  If so, we can make a case based on the fact that PTSD is marked by measurable physical changes to the brain. We will also make sure that we are applying the right standard of disability for your claim.

When appealing a LTD denial when you are disabled from PTSD, you need to consider:

  • How is disability defined? Is it your own occupation, which is the job you had before you became disabled, or any occupation?  If it’s any occupation, it may include many jobs a vocational expert will claim you can perform. 
  • Do you have a psychiatrist who will write a detailed statement as to why you can't work?  Have them go over the report from the insurance company’s medical and vocational expert to explain why they are wrong.
  • Make sure all the legal requirements for ERISA are met and your appeal is filed on time.

Get Help from Our Long-Term Disability Attorney

If you’ve received a denial of long-term disability benefits for PTSD, the stress of dealing with the situation can easily make your symptoms worse.  Let us help prove that you need the benefits you are being denied. 

Our attorney is experienced in handling long-term disability appeals that are subject to ERISA laws.  Call us today at 816-203-0143 or online through our website contact form or chat for the help you need and deserve.  You can also instantly download our free long-term disability guideWe're here to help and on your side!



Kevin J. McManus
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Kevin McManus is an accident injury and disability lawyer in Kansas City, MO, and Overland Park, KS
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