For many people, “seeing is believing.” But if you’re looking at a person who has an invisible disability, what you’re seeing can often be deceiving. And, when a person with an invisible or hidden disability attempts to access long-term disability benefits from insurers, seeing can become disbelieving. In this blog post, I define invisible disabilities, explore one of these disabilities (post-traumatic stress disorder) in more detail, and explain why and how persons with these disabilities can be doubly disadvantaged when dealing with insurance companies.
Invisible disabilities
A disability is a physical, cognitive, mental, intellectual, neurological, sensory or developmental condition that impairs, hinders, interferes with or otherwise limits a person’s ability to engage in certain activities. A person who has an invisible or hidden disability may not present with any outward signs of this condition. Living in a seemingly able-centric society presents varying challenges and constraints for people with disabilities. For a person with an invisible disability, his or her condition can be a double-edged sword. On the one hand, those with invisible disabilities may choose not to disclose their condition or illness to avoid unwelcome social stigmas or potentially jeopardizing their employment. On the other hand, greater visibility of such a condition can contribute to positive changes or accommodations that facilitate acceptance and increased participation within society.
Post-traumatic stress disorder
When a person witnesses or experiences one or a series of traumatic events, it may trigger high levels of stress hormones such as adrenaline. This reaction can cause significant changes in neurological patterns and biochemistry in the brain. In some cases, these changes will result in a condition called post-traumatic stress disorder (PTSD).
A person with PTSD may experience disturbing thoughts or feelings related to reliving the traumatic experience, negative thoughts or moods, persistent attempts to avoid cues that remind a person of the trauma, and heightened reactions to stress. These symptoms can disturb sleep or concentration, cause reckless or destructive behaviour, and lead to periods of dissociation.[i] Most people who experience a traumatic event will have some initial and temporary difficulty coping and adjusting without developing PTSD. Persistent symptoms that appear a month or more after the traumatic event (possibly not appearing until years later) may be indicative of PTSD. Research suggests that certain factors such as genetics, prolonged exposure, or a high-impact event such as interpersonal violence or sexual assault may increase the risk of developing PTSD.
The American Psychiatric Association added PTSD to the Diagnostic and Statistical Manual of Mental Disorders in 1980, but the symptoms associated with the condition had been observed by psychiatrists for decades. Initially most closely associated with veterans of the military (variously referred to as shell shock, battle fatigue, combat neurosis or railway spine, among others), by the second half of the 20th Century sociologists began to note how civilians who experienced war atrocities and domestic abuse survivors exhibited similar post-stress responses. The key change with the concept of PTSD was the idea that “the etiological agent was outside the individual rather than an inherent individual weakness.”[ii] Some traumatic events that could lead to PTSD include war, crime, major accidents, interpersonal violence, and disasters.
Living with PTSD
PTSD can be a debilitating condition that may cause significant problems with relationships, work, school, or other activities. Other common problems for people with PTSD include depression, panic attacks, alcohol and substance abuse problems, physical symptoms, and an increased risk of medical issues. However, the nature of the disorder means not all these issues are easily identifiable to other people, and persons suffering from PTSD may try to hide the extent of their suffering to keep working or maintain their lifestyle. Concealing their struggles could also lead to a delayed diagnosis of the condition. While there are treatments for PTSD, including certain medications and counselling, some people may reach a point whether their condition leaves them unable to work for extended periods of time.
Why do insurers deny long-term disability (LTD) benefits for PTSD?
Insurance adjusters considering an LTD claim for PTSD may be skeptical of the extent of suffering caused by PTSD precisely because the symptoms are not overtly visible. Before approving or denying an LTD claim for PTSD, an insurer may have surveillance conducted on the claimant to corroborate (or challenge) the information concerning the disability found within the patient’s medical records. While the insurance company has the right to observe or monitor an insured’s activities carried out in public, how the insurer interprets what is seen can lead to unfair denials. For example, certain triggers that cause panic attacks or reliving of the trauma may be highly situational. If a person is away from an office space or worksite where she has been triggered in the past, she may not demonstrate similar responses while under observation. Moreover, if a person with PTSD is experiencing depression, one of the therapies that may be recommended to improve symptoms is participation in enjoyable activities and socializing with friends. Photo and video surveillance of these activities may be used to argue that a claimant is not terribly depressed at all and is frequently out having fun. Other symptoms such as headaches or pain are not often independently verifiable and depend on a claimant’s reports to medical providers. In short, for some insurers, seeing is disbelieving when it comes to a person living with PTSD. Since ‘invisible’ injuries and conditions can be difficult to prove, it is particularly important that medical advice and treatment be pursued and documented so that a diagnosis can be made and a record of the symptoms and associated impact on work, family and social life can be generated. Such documentation will be an important part of the legal foundation for advancing a Long-Term Disability claim. Keep in mind that a principal reason for the denial of LTD claims by insurers is the absence of a solid medical foundation to support the claim.
What can be done?
If you or a loved one is suffering from PTSD and your LTD claim has been denied or delayed, a long-term disability lawyer who has experience handling invisible disabilities can help. At Gluckstein Lawyers, you can trust our team to listen to your story with great attention and compassion. We will offer you options for how to proceed with your case and explain how we have successfully dealt with similar cases in the past. If you choose to work with us, we will ensure you are kept well informed and feel comfortable to ask us any questions as we build your case and advocate on your behalf. To learn more about how our commitment to full-circle care can help you, contact David Lackman.
[i]Learn about PTSD - Veterans Affairs Canada
[ii]PTSD History and Overview - PTSD: National Center for PTSD (va.gov)