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Do I Qualify For Disability Insurance Benefits for Post-Traumatic Stress Disorder PTSD?

CaveyLaw.com > Practice Areas  > Long Term Disability & ERISA Lawyer  > Long Term Disability Disabling Conditions > Do I Qualify For Disability Insurance Benefits for Post-Traumatic Stress Disorder PTSD?

Disability insurance companies don’t always make it easy for policyholders who have post-traumatic stress disorder (PTSD) to get the disability benefits they deserve.

Americans of all ages and sex can experience PTSD, which results from accidents, interpersonal violence (assault, sexual violence), a stressful employment situation or as a result of military service.

PTSD, a type of anxiety disorder, is triggered either by experiencing or witnessing a terrifying event. Many people who go through or witness such an event have only temporary difficulty adjusting and coping.  They improve with time and treatment.

But you probably have PTSD if the symptoms get worse, continue for months and even years and interfere with your ability to function. Symptoms, which can vary in intensity and over time, include flashbacks, nightmares, uncontrollable thoughts about the event and severe anxiety.

Many claims are denied because the disability insurance company says:

(1) There is no objective basis of the diagnosis,

(2) There is no objective basis for the restrictions and limitations assigned by your physician, or

(3) There is no causal relationship between your PTSD and/or your restrictions and limitations, and your inability to do your own or any occupation.

Why The Definition of Mental or Nervous Conditions In Your Policy Is Key

If there is no mental nervous limitation in your policy, you are lucky. You will be eligible for benefits for the life of the policy if you remain disabled.

How your policy defines “mental illness” or “nervous conditions” is key to how long you get disability benefits. Many policies limit benefits to 24 months.

There is NO uniform policy definition for these terms, and many were written poorly. Some disability insurance policies define mental illness as:

  • “Any psychological, behavioral, or emotional disorder,”
  • “Any disorder found in the current diagnostic standards manual of the American Psychiatric Association.”

Other policies list conditions they have decided are mental or nervous conditions and list other conditions they have decided are not.

Some policies also limit benefits to 24 months if any mental nervous condition contributes in any way to your overall disability.

It is not uncommon for Ms. Cavey to represent a policyholder who has PTSD with depression, alcohol or drug problems and eating disorders. Some policies limit coverage for alcohol or drug problems and even for eating disorders. A carrier will mischaracterize a policyholder’s problems so the carrier has to pay only 24 months of benefits.

Sometimes disability carriers take a hard line and deny a PTSD claim of a veteran or first responder based on the “act of war” exclusion provision included in most disability policies.

Nancy Cavey, who has 35 years experience handling disability cases, has battled often with disability carriers about these ambiguities. Courts have reached many different decisions on what mental nervous policy terms mean. It is crucial you know what the courts will do before you apply for benefits, and that you fill out your application properly.

She works closely with you, your family and your physician to overcome a claims denial or termination of benefits after 24 months.

Nancy Cavey offers a free initial consultation and welcomes the opportunity to speak with you about your disability claim.

What Mental Conditions Can Have Limited Pay Periods

PTSD can be seen in combination with depression. Look closely at your policy as there can be limited pay periods for:

Anxiety disorders, including:

  • Generalized anxiety disorder;
  • Various phobic disorders like simple phobia, social phobia and agoraphobia;
  • Panic disorder; and
  • Post-traumatic stress disorder (PTSD).

Depressive disorders including:

  • Major depression;
  • Dysthymic disorder;
  • Psychotic depression; and
  • Bipolar disorder.

What Other Games Do Carriers Play with Mental Nervous Condition Clauses?

Disability carriers will try to characterize your physical problem as a mental problem. Carriers will approve benefits for a mental health condition like PTSD but ignore your physical problems.

Before you apply for benefits, it is crucial that you understand the games carriers play and how they manipulate the mental nervous limitations to their advantage.

Don’t forget the carrier will do a file review months before the 24-month limitation runs. They will be looking in your medical records for continuing mental health problems so they can say, “Got you!”

Nancy Cavey will make sure your physical disability is well developed in your medical records and that your doctors properly comment that you are NOT disabled as a result of any mental conditions, including PTSD.

It takes teamwork!

How Do I Get The Disability Insurance Benefits I Deserve?

PTSD can make it difficult, if not impossible, to do things around your home and work.  PTSD can damage and even destroy professional relationships and result in poor work performance. You might have intrusive memories, difficulty concentrating, avoid social interaction and even engage in self-destructive behavior.

If you no longer can work or your doctor has told you to apply for disability benefits, you should take steps before you apply:

  1. Obtain a copy of your disability policy. See how it defines “disability,” “occupation” and “self-reported conditions.” You’ll need to understand what you have to prove to get your benefits because of PTSD or any other mental or nervous condition.

The mental nervous limitation in your policy can classify PTSD as a mental disorder, or the policy can be silent on the issue. You’ll want to know what your policy says before you apply for benefits. You’ll also want to know if the policy limitation applies if your mental nervous condition contributes to your disability to any degree.

  1. Obtain a copy of your medical records. Review them to see if there is an objective basis for your diagnosis, what your records say about your report of symptoms and your restrictions and limitations. Psychological testing should be included in your records.
  1. Obtain a copy of your personnel file to see if your mental or nervous problems have affected your work performance.
  1. Obtain a copy of your job description. Create your own description of your physical duties with an explanation of how your symptoms impact your ability to do your occupation.
  1. Provide your doctor with the occupational description. Ask your doctor to prepare a report that explains the objective basis for your diagnosis, the objective basis of your restrictions and limitations, and the objective reasons you can’t perform some or all of the material and substantial duties of your occupation.
  1. Prepare a diary that explains and gives examples of how your symptoms interfere with your ability to do things on a daily basis and the side effects of your medication.
  1. Hire Nancy Cavey to help you file your initial application. The application process is confusing and designed so you and your physician make mistakes that can result in a delay or even a denial of your benefits. Ms. Cavey knows how to prepare and file a winning shock and awe disability application that leaves the carrier little reason to question your claim.
  1. Hire Nancy Cavey to help you appeal a wrongful denial or termination of your disability benefits. Disability carriers are in the business of collecting premiums and not paying disability benefits for PTSD. Carriers routinely cut off benefits at 24 months and misapply the mental nervous condition limitations.

They’ll use any reason to deny your claim. The odds of getting your benefits on appeal are greater when you are represented by an experienced ERISA/private ID policy disability attorney.

Contact Disability Attorney Nancy L. Cavey, Who Can Help You Regardless of Where You Live

PTSD can make it difficult, if not impossible, to work. You owe it to yourself and your family to get help today! Nancy Cavey can review your policy and your medical records, and explain to you what your policy says and how to get your disability benefits.  Call today for a free consultation at 727-894-3188.

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