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Worker files lawsuit to fight denial of LTD insurance for PTSD

Awareness of Post Traumatic Stress Disorder has increased in recent years, especially in light of news reports about veterans and warriors suffering from the condition after serving our country. What many people are not aware of is the fact the PTSD is not solely linked to military service. Any terrifying or traumatic event can serve as the basis for PTSD – ranging from being in a car accident to witnessing the death of a loved one.

Professionals estimate that 70 percent of adults have experienced at least one traumatic event during their lives. Most events do not lead to PTSD. However, roughly 20 percent of people who experience these events develop some level of PTSD. When the effects of this mental health condition begin to impact a person’s ability to continue working, it is important to evaluate whether the worker has long-term disability insurance coverage.

Does LTD Insurance Cover PTSD?

LTD insurance coverage issues are highly complex. Many insurance policies impose limitations on the potential duration of coverage for mental health and anxiety issues. Insurance companies often read exclusions to coverage broadly, hoping to find a legal basis to deny a claim outright. Moreover, some claims are denied on tenuous legal grounds as the insurance providers expect that a portion of claimants will simply accept the denial –even it rejecting the claim is unfair.

A recent case from the West Coast highlights how insurance companies may provide more than one reason to deny benefits. An Iraq war veteran developed symptoms of PTSD during the summer of 2015, according to the Northern California Record. At the time, he was working in the private sector as a software engineer and had short- and long-term disability coverage through a company sponsored ERISA plan.

He sought, and received short-term disability benefits under the plan until he was terminated from his job in June of 2016. At that time, his insurance provider denied his claim for long-term disability benefits. The insurance company reportedly is disputing the PTSD diagnosis altogether, and also arguing that the condition is not covered under the terms of the veteran’s policy.

Far too often, valid disability benefits claims are denied or terminated prematurely under the guise of a legal argument. It is critical to work with a dedicated bad-faith insurance and ERISA litigation lawyer who knows how to evaluate the variety of issues that can arise, including legal disputes, medical evaluations and often, vocational issues that insurance companies may rely on to discontinue benefits based upon the argument that a worker has sufficient skills to work some new capacity.

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DeBofsky, Sherman & Casciari, PC