PTSD & Long-Term Disability Benefits

Hamilton Disability Lawyers Serving Clients with PTSD Throughout Ontario

By Matt Lalande, Esq

There’s no doubt that uncontrollable, devastating experiences can negatively your life, generate feelings of being unsafe, powerless, vulnerable, damage your psychological stability and take away your sense of well being.  Terrifying occurences that force our way into our lives such as chronic occupational hazards, repeated or extreme exposure to aversive details of a traumatic event, repeated or extreme occupational exposure to traumatic events, abuse, assaults, fires, witnessing death, injury, being involved in a serious car accident, motorcycle accident, or trucking accident can cause a group of symptoms called Post-traumatic Stress Disorder (PTSD), which is a terribly powerful condition that can be extremely difficult to cope with, cause occupational instability, marital problems, family discord, and difficulties in parenting. In fact, in some disability cases that we have seen, claimants have undergone many sessions of psychotherapy and pharmacological treatments for their PTSD and unfortunately their symptoms never fully resolved.

What is PTSD?

Posttraumatic stress disorder (PTSD) is a chronic, often debilitating mental health disorder that may develop after chronic exposure to trauma or to a very serious traumatic life event (scary and shocking life changing events) that leaves a seriously enduring footprint on a person’s life. Terribly traumatic events can result in chronic frightening memories, the inability to speak about the incident, images related to trauma can linger along with feelings of terror and depression. Chronic occupational trauma or chronic abuse can be also so terribly devastating that it could interfere with the ongoing development or adversely affect the foundation of the victim’s personality. When these types of symptoms interfere with a person’s life to a significant degree it could be an indication that the particular victim has developed posttraumatic stress disorder.

How is PTSD Diagnosed?

Post-traumatic stress disorder (PTSD) was first diagnosed in 1980 and is found in the subsection of a book called the DSM, under “Trauma and Stressor-Related Disorders”.  The DSM is the handbook that has been used by psychologists, psychiatrists and other health care profesionals in Canada for the past 60 years as the authoritative guide to the diagnosis of mental disorders.  It is often thought of as the psychiatrist’s “bible”.  It is a comprehensive classification of mental disorders with criteria that establishes standards by which your doctor classifies, diagnoses, and ultimately treats your disorders.

The manual contains descriptions, symptoms, and other criteria for diagnosing mental disorders.  The essential feature of PTSD is the development of characteristic symptoms following exposure to one or more traumatic events.

The diagnostic criteria of PTSD are as follows:

1. Exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways:

• Directly experiencing the traumatic event
• Witnessing, in person, the event as it occurred to others
• Learning that the traumatic event occurred to a close family member or close friend
• Experiencing repeated or extreme exposure to aversive details of the traumatic event. (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse, etc.)
• Presence of one or more of the following intrusion symptoms

2. Presence of one or more of the following intrusion symptoms associated with the traumatic event, beginning after the traumatic event occurred:

• Recurrent, involuntary, and intrusive distressing memories of the traumatic event
• Recurrent distressing dreams in which the content or effect of the dream are related to the traumatic event
• Dissociative reactions (e.g., flashback) in which the individual feels or acts as if the traumatic event were recurring
• Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
• Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event

3. Persistent avoidance of stimuli associated with the traumatic event, beginning or worsening after the traumatic event occurred, as evidenced by one or both of the following:

• Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event
• Avoidance or efforts to avoid external reminders that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event

4. Negative alterations in cognition and mood associated with the traumatic event, beginning or worsening after the traumatic event occurred, as evidenced by two or more of the following:

• Inability to remember an important aspect of the traumatic event (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs)
• Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
• Persistent distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blame himself, herself, or others
• Persistent negative emotional state
• Markedly diminished interest or participation in significant activities
• Feelings of detachment or estrangement from others
• Persistent inability to experience positive emotions

5. Marked alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the traumatic event occurred, as evidenced by two or more of the following:

• Irritable behavior and angry outbursts typically expressed as verbal or physical aggression toward people or objects
• Reckless or self-destructive behavior
• Hypervigilance
• Exaggerated startle response
• Problems with concentration
• Sleep disturbance
• Duration of disturbance (criteria B, C, D and E) is more than one month.
• The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The disturbance is not attributable to the psychological effects of a substance or other medical condition.

Who gets PTSD?

Anyone can develop PTSD at any age, many of which have been reported to be:

• victims of violent crimes such as bombings or shootings;
• witnesses or survivors of violent crimes and violent acts;
• civilians caught in war zones;
• combat veterans;
• neglected or abused children;
• victims of disaster events;
• victims of natural catastrophes such as hurricanes, tornadoes etc;
• victims of dog attacks or animal assaults;
• victims of motor vehicle accidents – such as car accidents, motorcycle accidents, pedestrian or trucking accidents;
• witnesses to motor vehicle accidents and witness to occupant injury;
• medical personnel and emergency responders who assist in accident and disaster situations;
• firefighter personnel who assist in accident and dangerous situations; and
• police officers and other responders to accident and dangerous situations.

Common Emotional Responses and Psychiatric Disorders Following Traumatic Events

There has been elong-standing medical evidence demonstrating that, among the anxiety disorders, PTSD is one of the most strongly associated with:

• suicidal behaviour;
• interpersonal problems;
• parenting difficulties;
• alcohol and drug abuse;
• loss of job;
• the inability to work;
• reductions in household income and;
• accompanying mental and physical health diagnoses.

PTSD can also include additional emotions such as fear, depression, shame, guilt, anger, and grief. Trauma victims may also have difficulty imagining that they can go on with life and are known to generally feel that they are now “different from others”. Their devastating and traumatic experience seems so removed from normal life that they feel set apart from others. They believe that others, no matter how close, will never really understand how they feel or cannot really appreciate what they have been through.

In addition to or along with PTSD, there are other psychiatric disorders  that follow traumatic events sucgh as:

Adjustment Disorder – most commonly, the diagnosis is an Adjustment Disorder, this is a relatively mild, relatively brief disruption of functioning.  Mood may be anxious or depressed or both.  Conduct, especially in children, may be impaired.  The diagnosis is often applied during marital and occupational difficulties and need not have a major trauma to justify its use.  When a major trauma causes minor impairment, but enough disability to warrant psychiatric treatment, the diagnosis will be Adjustment Disorder.  At the other end of the spectrum are psychotic and severe dissociative states.  These are not common.

Psychosis – is usually defined as a break with reality. Brief psychotic disorder may include hallucinations and delusions unrelated to the trauma.  Voices may order the person to harm another or to harm himself, even though the trauma had no such content.  Delusions are fixed, false beliefs, often of persecution or grandiosity or both.  Delusions may be intricate and bizarre, with or without accompanying hallucinations.

Dissociation – is an altered state of consciousness.  One is not oneself, but not out of touch with reality.  In a fugue state, people can travel long distances for no apparent reason, converse with strangers, appear normal, have no hallucination and no delusion, but eventually return to their original self and original awareness, baffled by finding themselves in a city hundreds of miles from home.  Depersonalization, derealization, psychogenic amnesia, and multiple personality are also dissociative conditions.

Medical disease – many traumatized people will develop physical diseases or exacerbate preexisting conditions. Psychosomatic pathways are involved, so these medical problems have psychiatric labels as well. The cardiovascular system, the gastrointestinal tract and the respiratory system are well recognized by the general public as vulnerable to stress.  Hypertension, heart attack, stroke, ulcers, and asthma can follow intense events.

Victims of cruelty –  (as opposed to victims of natural disasters) experience additional emotional difficulties which are not listed in the official diagnostic manual and are not part of PTSD.  Foremost among these is shame.  Although violent criminals should feel ashamed, they seldom do.  Instead, the victim who has been beaten, robbed, or raped is humiliated.  This person has been abruptly dominated, subjugated, stripped of dignity, invaded, and made, in his or her own mind, into a lower form of life.  Who cannot recall being bullied as a child, forced to admit weakness, mortified by the process?  As an adult, this shame quickly becomes self-blame:  Why was I there?  What could I have done differently?  Why did I let it happen?  Self-blame may actually be a good sign, correlating with self-reliance and self-regard.  But it may also be hostility turned inward, a relentless self-criticism and downward spiral into profound depression.

Hatred –  is another chronic human emotional response to trauma with no reference in the diagnostic manual.  Victims of cruelty are entitled to hate their abusers, on the path to recovery and possible forgiveness.  But survivors often do less hating than one might expect.  Sometimes they are simply grateful to be alive

PTSD and the Inability to Work

The issue of PTSD and work is person and fact specific. While some people can continue to function and work, some cannot. It’s clear that PTSD can lead to very serious complications and debilitating symptoms such that that a victim may find it difficult or impossible to return to normal functioning or his or her job.  PTSD, for some, can complicate and impact every day functioning with chronic symptoms such as intrusive memory, avoidance, unstable reactions, unstable behavior, negative thoughts, negative moods, disassociation, avoidance issues, hypervigilance, reckless or self-destructive behavior etc. can all contribution to the victim’s inability to resume the substantial duties of his or her regular employment.

PTSD often manifests with physical symptoms as well, especially as a result of stress, anxiety and depression. A person could experience ongoing and persistent fatigue, dizziness, headaches and pain ect. Overall, the question of whether or not somebody’s PTSD symptoms are so debilitating that it makes them impossible to perform their everyday job responsibilities is a question that is  fact specific to each particular case.

Am I eligible for disability benefits if I suffer from PTSD?

Again, if your symptoms are so debilitating that it makes it impossible for you to complete the substantial duties of your own employment, then yes, you should apply for long-term disability.

What should I do if I suffer from PTSD and I’ve been cut-off or denied long-term disability?

Unfortunately PTSD is not recognized by victims after every traumatic stressful event. PTSD often takes time to develop. Particularly, with first responders, symptoms of PTSD can slowly develop over months, years or even decades when being chronically exposed to potentially traumatic events repeatedly well on the job. We have seen claims denied for issues such as problems with the date of onset of disability, and adequate medical support and treatment, the failure to participate in a medical program, long-term disability insurance companies “pawning off” the claims to WSIB amongst other reasons.

In short, you must satisfy the definition of total disability in your particular long-term disability policy. Typically, for the first two years or 24 months of disability, a claimant must be unable to perform the substantial duties of his or her own employment. After 24 months, there is a threshold type test, which changes the definition of total disability to that of “any occupation” – meaning you must be disabled from any occupation for which you are reasonably suited by education training and experience.  Even if your policy doesn’t contain the words “reasonably fitted by education, training or experience,” proposed occupations must be something for which the claimant is qualified by virtue of his schooling and work experience

The test of total disability is particular to each individual policy, however, the onus is on you to prove that you are unable to work and establish that you are entitled to long-term disability benefits. Often this cannot be done without a disability lawyer who not only build a proper case for you with the appropriate medical experts to prove you can’t work, but help contextualize your disability by acknowledging areas of your continued capabilities, portray your non-vocational limitations, interview the proper medical professionals, your family and friends and show a court the impact which your disability has had your and your family members lives.

Contact our Hamilton disability lawyers, serving Ontario, if you have been wrongfully denied or cut off from your long-term disability benefits.

If your insurance company is wrongfully denied or cut off your long-term disability benefits, call our Ontario disability lawyers in Hamilton, serving province-wide. Matt Lalande has been representing disability claimants who have been unlawfully denied their long-term disability benefits since 2003. Call us today at 905-333-8888, toll-free at 1-844-LALANDE (525-2633) or fill in a contact form today the schedule your no obligation consultation.  Remember our consultations are free and our Hamilton disability law firm never asks our clients for payment up-front.

*special thanks to the authors in the American Journal of Psychiatry and the New England Journal of Medicine, and California psychiatrist and friend Dr. Koziauj for their contributions to this page.