PTSD and Long-Term Disability Benefits in Canada

Post-Traumatic Stress Disorder (PTSD) can significantly impact an individual’s life, including their ability to work. Understanding how PTSD affects long-term disability benefits is crucial for those facing denials and seeking legal support.

Understanding PTSD

PTSD is a mental health condition that can develop after experiencing or witnessing a traumatic event. In a recent survey, Statistics Canada learned that 5% of respondents reported a PTSD diagnosis, and that 8% of respondents met the criteria for possible PTSD based on symptoms they had experienced in the past month.

Symptoms may include flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event, which can disrupt daily life and work functions. Here are some ways in which PTSD may affect someone’s work capacity:

Flashbacks and Intrusive Memories:

PTSD can cause vivid flashbacks or intrusive memories of traumatic events. These sudden and distressing recollections can occur at any time, making it challenging to focus on work tasks or maintain concentration.

Hyperarousal Symptoms:

People with PTSD may experience hypervigilance, irritability, or an exaggerated startle response. These heightened states of arousal can make it difficult to feel safe or at ease in a work environment, leading to increased stress and reduced productivity.

Avoidance Behaviors:

Individuals with PTSD often engage in avoidance behaviors to escape reminders of their trauma. This may include avoiding specific places, people, or activities associated with the traumatic event. In a work setting, avoidance behaviors can limit job responsibilities or interactions with colleagues and clients, affecting job performance.

Emotional Dysregulation:

PTSD can cause intense and unpredictable mood swings, including feelings of anger, sadness, or detachment. These emotional fluctuations can impact work relationships, teamwork, and overall job satisfaction.

Sleep Disturbances:

Many individuals with PTSD experience sleep disturbances such as insomnia or nightmares. Chronic sleep deprivation can lead to daytime fatigue, difficulty concentrating, and decreased work efficiency.

Cognitive Impairments:

PTSD can impair cognitive functions such as memory, decision-making, and problem-solving skills. These cognitive deficits can hinder job-related tasks that require attention to detail, critical thinking, or multitasking.

Functional Impairments:

Depending on the severity of symptoms, individuals with PTSD may struggle to meet job demands related to attendance, punctuality, meeting deadlines, and adapting to changes in the work environment.

Interpersonal Challenges:

PTSD symptoms can interfere with interpersonal relationships at work, leading to conflicts with supervisors, coworkers, or clients. Difficulties in communication, trust issues, or social withdrawal can impact teamwork and collaboration.

Physical Symptoms:

In addition to psychological symptoms, PTSD can manifest as physical health issues such as headaches, gastrointestinal problems, or chronic pain. These physical symptoms can further limit an individual’s ability to perform job duties effectively.

Work-Related Triggers:

Certain job-related triggers or stressors may exacerbate PTSD symptoms, making it challenging to sustain employment without accommodations or support.

PTSD and Long-Term Disability

If PTSD symptoms make it challenging to perform job duties due to triggers, anxiety, or other related issues, individuals may be eligible for long-term disability benefits in Canada.

Is PTSD Covered by my LTD Policy?

Many long-term disability policies cover mental health conditions such as PTSD. It’s crucial to review policy details and understand coverage limitations related to mental health.

PTSD Disability Benefits

To support a PTSD disability claim, documentation from mental health professionals detailing diagnosis, symptoms, treatment history, and functional limitations at work is essential.

Can My Disability Benefits Be Denied?

Unfortunately, PTSD claims can be denied due to various reasons. It’s vital to understand the myriad denial reasons and options you have for appeal. Here are some of the reasons why your benefits may be denied:

Insufficient Medical Evidence:

One of the primary reasons for LTD denials is a lack of comprehensive medical evidence supporting the severity and functional limitations caused by PTSD. Inadequate documentation from healthcare providers, incomplete medical records, or missing diagnostic tests and evaluations can lead to denials.

Misinterpretation of Symptoms:

PTSD symptoms can be complex and varied, including flashbacks, nightmares, hyperarousal, avoidance behaviors, and emotional dysregulation. Insurers or claims reviewers may misinterpret these symptoms or downplay their impact on work-related functions, leading to denials based on perceived inconsistencies.

Policy Exclusions:

Some LTD policies may have specific exclusions or limitations related to mental health conditions such as PTSD. Insurers may deny claims based on policy provisions that restrict coverage for certain psychiatric disorders or impose stringent criteria for proving disability related to mental health.

Incomplete Application or Documentation:

Failing to provide thorough and accurate information in the initial application for LTD benefits can result in denials. Missing deadlines, incomplete forms, or insufficient details about medical treatment, functional impairments, and work-related limitations can weaken the disability claim.

Failure to Follow Treatment Plans:

Insurers may require claimants to follow prescribed treatment plans, including therapy, medication management, and regular medical appointments. Non-compliance with recommended treatments without valid reasons can be used as grounds for denying benefits.

Pre-Existing Conditions:

If PTSD is considered a pre-existing condition or if there are indications that symptoms existed before the insurance coverage started, insurers may dispute claims based on the argument that the disability was not new or unrelated to prior medical history.

Independent Medical Examinations (IMEs):

Insurers often request claimants to undergo Independent Medical Examinations conducted by healthcare professionals chosen by the insurer. If the IME report contradicts the claimant’s treating physician’s assessments or downplays the severity of PTSD symptoms, it can lead to benefit denials.

Functional Capacity Assessments:

Insurers may conduct functional capacity assessments (FCAs) to evaluate an individual’s ability to perform work-related tasks. If the FCA report suggests that the claimant can perform some job functions despite PTSD-related impairments, it may be used as a basis for denial.

Dispute Over Occupational Disability:

PTSD’s impact on occupational disability can be complex, especially if the individual has a job with varied responsibilities or is capable of performing some tasks intermittently. Insurers may dispute the extent of occupational disability and definitions of “total disability” leading to denials or benefit reductions.

Appeals Process Challenges:

After an initial denial, navigating the appeals process without legal representation or adequate support can be daunting. Missing deadlines, submitting incomplete appeal documents, or failing to address denial reasons effectively can result in upheld denials.

Navigating LTD benefit denials related to PTSD requires a thorough understanding of the insurance policy, diligent gathering of medical evidence, clear communication with healthcare providers, and often legal assistance from a disability lawyer familiar with mental health claims.

What To Do If My LTD Benefits Have Been Denied?

Seeking legal assistance from an LTD disability lawyer is advisable if PTSD benefits are denied. Lawyers can review denial reasons, gather additional evidence, and navigate the appeals process effectively.

Contact a Disability Lawyer About Your LTD Denial Today

If you’ve faced a denial for PTSD disability benefits, contacting one of Preszler Injury Lawyers’ disability lawyers who handles LTD denials to help protect your rights and get the benefits you’re entitled to.