Winning Long Term Disability Benefits For Ptsd From The Insurance Company
Convincing the insurance company that PTSD is a disability can be an uphill battle. What does it take to show an insurance carrier that you are unable to work because of your disorder and its complications?
Your first action is to read the policy and understand any limitations and exclusions. Here are a few common restrictive provisions written into most long term disability policies:
- Insurance policies often take a hard line and limit coverage of mental and nervous conditions. This umbrella term generally limits PTSD and other mental health disorders to 24-months coverage. If you are awarded short-term disability benefits, just as the 24-months of benefits expire the insurer will say you do not qualify for long-term disability, and disability payments will end.
- LTD policies often have an act of war exclusion upon which insurers may try to base denials of disability benefits for PTSD.
- Most insurance policies will require that you also apply for Social Security disability benefits. The reason is, any disability payments the insurance company pays you will be offset by the amount of your Social Security disability payments. And just because Social Security approves your disability claim for PTSD, this has no bearing on whether your insurance company will approve your claim for long-term disability benefits for PTSD.
Can You Get Disability For Ptsd
You are able to have a successful disability claim for PTSD, but in order for you to get disability for PTSD it needs to be properly medically documented. In order for you to get disability for PTSD, you need to have as much medical documentation as possible.
In your application, the SSA will ask for your medical records, including hospital records and clinic notes from physicians, therapists, and counselors.
When you are applying for disability with PTSD, you should ask your doctor to fill out a Residual Functional Capacity Evaluation on your behalf.
The RFC evaluation is a form that your doctor fills out that evaluates the maximum you can do despite your disability, such as PTSD.
Your RFC evaluation is another example of medical documentation that helps show that you are unable to work full time because of your PTSD. When you have as much medical evidence as possible that shows you are unable to work because of PTSD, the more likely you are to get disability benefits for PTSD.
Va Disability Ratings For Mental Health Conditions Related To Mst
MST is not a disability. However, the experience can trigger mental health conditions such as post-traumatic stress disorder and depression that are considered compensable disabilities when they are related to a veterans military service.
Mental health conditions are rated based on the severity of a veterans symptoms as outlined in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition published by the American Psychiatric Association . The VA describes this under their General Rating Formula for Mental Disorders by outlining the criteria for the various possible disability ratings. All mental health conditions, regardless of their cause, are rated using the same criteria.
A victim of MST who has been diagnosed with a condition such as PTSD or depression might receive any of the following VA disability ratings:
Also Check: What Does A Ptsd Flashback Look Like
What If You Dont Qualify For The Vas Automatic 50% Rating
If you do not meet the qualifications to receive the automatic 50% rating, dont worry just yet. You can still qualify for VA disability based on your PTSD diagnosis alone.
Any current or former member of the United States military that has been diagnosed with PTSD while carrying out their military duties could qualify to receive disability compensation benefits. As long as you can prove that you have PTSD due to your service in the military and did not receive a dishonorable discharge, you could qualify for VA disability benefits.
How The Va Appeals Process For Ptsd Works
The denial or award letter you received comes with a statement from the VA on how they reached their decision, so make sure you hang on to it. You can use this information to determine what new evidence you should submit with your appeal. Once you get a rating decision from the VA, you have a year to appeal. The general plan for appealing a claim is as follows.
- Have a VA-accredited claims agent or attorney review your claims file.
- Request any pertinent records that are missing from your claims file.
- If necessary, get buddy statements from friends and family, and additional statements from doctors.
- File the appeal with the new evidence and send a brief to your VA Regional Office or the Board of Veterans Appeals.
Not every appeal follows this pattern to a T, so its best to consult with an experienced claims agent to get a better sense of how things will go.
Now lets take a closer look at types of evidence that can help you show that your PTSD rating is in need of revision.
You May Like: When Diagnosing Schizophrenia A Negative Category Of Symptoms Refers To
Am I Eligible For Va Disability Compensation
Veterans with a service-connected physical or mental disability that makes everyday tasks difficult or impossible may be eligible for VA disability benefits.
Eligibility to file a VA disability claim is dependent on meeting one of the following conditions as set by the VA:
- A Veteran who became sick or injured while serving in the military, or
- A Veteran with an illness or injury before enlisting that was worsened by service, or
- A Veteran with a service-connected disability that didn’t appear until after separating from the military
The VA will need evidence to support your disability claim when applying, which we discuss in the next section.
What Is Markedly Restricted As It Pertains To The Eligibility For The Disability Tax Credit
is also identified as a qualifying criterion when:
- The individual cannot perform, or take an inordinate amount of time to complete two or more of the ADLs listed above, even with therapeutic assistance, technological/adaptive devices, and/or medication.
- inordinate amount of time: usually three times longer than the amount of time an abled person of the same age would take to complete the activity.
- The severe restriction must affect the individual 90% of the time or more. The combination of two or more moderate restrictions such as walking and dressing, for example, cumulatively, adds up to a 90 percent restriction.
For example:
Greg M, was diagnosed in 2005 with Osteoarthritis, underwent knee surgery in the same year due to tears in both knees. It takes him 3 times longer than a normal person to walk or perform any other activities in daily living. Greg has to sit to put on garments and socks. His wife does most of the housework due to his severe condition. Gregs impairment is considered markedly restricted and his application was approved by the CRA
Also Check: Is There A Medication For Schizophrenia
Assistance With Your Claims And Appeals
PTSD is an all-too-common condition suffered by veterans, and no matter how mild or severe it may be, it warrants compensation from VA. Build the strongest case you can to file a claim or an appeal with us today. You can contact us at 844-VET-LAWS to ensure that you receive the appropriate compensation for your PTSD.
Were There When You Get Married
Whether youre celebrating your anniversary or starting a new chapter alone or with a new spouse, a part of that new life may include a new name. If you legally change your name due to marriage, divorce, or any other reason, let us know so you can get an updated Social Security card and so we can accurately keep track of your earnings. Theres no charge for a.
Recommended Reading: How To Stop Anxiety Tics
Social Security Disability Benefits Pay Chart 2022
Social Security disability payments increased by 5.9% in 2022. See how much you can earn in this Social Security Disability Benefits Pay Chart guide.
The Social Security disability benefits pay chart applies only to payments through the SSI program. It does not apply if the benefits you receive are through the Social Security Disability Insurance program.
Fully Developed Disability Claims
The next fasted option is the Fully Developed Disability Claims program.
The primary difference between the FDDC program and filing a standard claim is the Veteran must provide all evidence upfront and certify thereâs no additional evidence needed to make a claim decision.
At a minimum, the Veteran should provide:
- All military personnel records on the condition, and
- All service treatment records on the condition, and
- All private medical records on the condition, and
- All VA health records or supplementary information about related VA health records that the VA can request on your behalf
If the VA requires additional information, the claim typically gets removed from the FDDC program and is processed as a standard claim.
Recommended Reading: How To Calm Bipolar Rage
Mental Residual Functional Capacity
One of the best ways to increase an applicants chances for approval with a mental illness such as PTSD is to have his or her treating doctor fill out a mental residual functional capacity form. Typically when an applicant initially files for disability benefits, a medical examiner from the SSA will fill out a mental RFC based on the applicants medical documentation. This form is an assessment of an individuals mental limitations caused by his or her disabling condition. The SSA will use this assessment to determine if the applicant is capable of working despite his or her limitations. If the applicant is seen as unfit for employment, the SSA will award the applicant Social Security Disability benefits.
However, this medical examiner makes a medical decision without even seeing the applicant in person. Because of this, the SSA gives more creditability toward a RFC filled out by the applicants treating doctor since the doctor has direct experience with the applicants disabling condition. To learn more, visit our page about Residual Functional Capacity.
Can I Get A Lump Sum For My Va Disability
Servicemembers rated 30 percent disabled or more qualify for monthly disability retirement. But those rated 10 percent or 20 percent by DOD can only get a lump-sum disability severance. Most DOD disabled retirees apply for a VA rating after leaving service. That can result in a higher rating and better benefits.
Read Also: De2525xx Supplementary Certification
Don’t Miss: What Depression Looks Like Meme
Why Va May Reduce Your Disability Rating For Ptsd
Your VA disability rating for PTSD is based on how your condition affects your ability to work and carry out daily living activities. When you get approved for benefits for PTSD or any other condition, VA assigns you a disability rating between 0 percent and 100 percent in increments of 10 percent.
This rating shows the level of functional impairment caused by your condition, based on VAs review of your medical records and supporting documents.
For PTSD and most mental disorders, you will receive one of six disability ratings: 0 percent, 10 percent, 30 percent, 50 percent, 70 percent, or 100 percent. The criteria to receive each of these ratings are:
The rating you receive is assigned by the VA when your service connection is established. But PTSD can either improve or deteriorate over time. If it does either, VA may attempt to raise or lower your disability rating to match your current condition.
Suppose you return from combat with PTSD so bad that you can barely leave the house or feed yourself, much less work. You apply for disability and submit ample supporting evidence detailing the extent of your condition. VA assigns you a 100 percent rating based on your inability to work or carry out daily living activities.
But then you undergo intensive therapy. One year later, you still have PTSD, but it is now moderate, and you can hold down a job. If the VA decides to re-examine you, it may lower your rating from 100 percent to 50 percent.
For a free legal consultation, call
Ssi/ssdi And Va Disability Benefits
Veterans may be eligible for Supplemental Security Income or Social Security Disability Insurance , in conjunction with, or as an alternative to VA disability payments. They may also use the Medicaid and Medicare health benefits that come with SSI/SSDI to supplement VA health services.
The definition of disability and application process is different for SSA and VA disability benefits, and Veterans may begin receiving SSA benefits while they are waiting on a VA benefit decision.
Recommended Reading: Does Ptsd Show Up On An Mri
Winning Social Security Disability Benefits For Ptsd
The SSA defines post-traumatic stress disorder as recurrent and intrusive recollections of a traumatic experience, which are a source of marked distress.
You may qualify for Social Security Disability benefits for PTSD if you satisfy several criteria specified in the SSAs medical Listing of Impairments.
PTSD is categorized as a Trauma and Stressor-Related Disorder, under SSA Listing 12.15. The medical requirements are spelled out in three parts, A, B, and C. Your symptoms must satisfy the requirements of paragraphs A and B OR A and C.
Part A is about medical evidence and documentation. Part A specifies five characteristics to diagnose a stress or trauma-related disorder, and all must be present.
Part B, which requires the extreme limitation of one, or of two, of the following areas of mental functioning:
Part C of the medical listing for Trauma and Stressor-Related Disorders requires that post-traumatic stress disorder is serious and persistent that is, you have a medically documented history of the existence of PTSD for at least 2 years, and there is evidence of both:
About Post Traumatic Stress Disorder
As stated above, Post Traumatic Stress Disorder once known as shell shock or battle fatigue syndrome, is a serious mental disorder that develops after an individual experiences or witnesses a horrific event. PTSD is the lasting repercussion of a traumatic experience in which serious physical and/or mental harm occurred. Such events include war combat, sexual abuse, natural disasters, witnessing a murder etc.
It is good to keep in mind that most people experience a traumatic event during their lifetime that can cause shock, fear, or guilt. However, this does not mean they have PTSD as these reactions are normal and will go away with time. It is much different for someone with PTSD because the feelings do not go away and actually tend to get much worse. The symptoms can become so bad that it interferes with a persons activities of daily living and occupation.
The symptoms of PTSD are grouped into three categories:
Intrusive or Re-experiencing Symptoms:
- Reoccurring, undesired memories of the horrific event
- Flashbacks or reliving the event as though it was happening again
- Nightmares and disturbing dreams about the event
- Emotional and physical distress to anything that reminds the person of the event
Avoidance Symptoms:
- Individual attempts to avoid talking or thinking about the event
- Individual avoids people, places and activities that remind them of the event
- Detachment and isolation from friends and family
Hyper-arousal Symptoms:
Read Also: What Are The Types Of Schizophrenia
Social Security Disability Insurance
This is available for adults with permanent disabilities, as well as their families. To qualify for mental health disability pay, you must have a mental health impairment that prevents you from working for at least 12 months. You must also have previously worked and paid into the Social Security program for at least five of the last 10 years.
Allocated monthly payments will be based on your average lifetime earnings over a certain period of years, also known as your average indexed monthly earnings . If you worked for many years earning a high salary, you would receive more disability pay than someone who worked for less time and had a low salary. As of 2021, the average monthly benefit for disability insurance is $1,153.
After 24 months of SSDI, you may receive Medicare benefits. If you are receiving veterans benefits, this wont affect your payment amount, but workers compensation might.
Can I Work With A Ptsd Va Rating
Yes, you can still work with a 100 percent schedular PTSD rating. You can work with any VA schedular rating however, with Total Disability Individual Unemployability, or TDIU there are income restrictions, even though you can still work. (For more on TDIU,
Veterans with a 100 VA disability from the VA for PTSD also qualify for Special Monthly Compensation, which is a higher rate of compensation that the VA pays to veterans with certain needs or disabilities .
Also Check: What It’s Like To Be Bipolar
Other Mental Health Disability Benefit Programs
If you have a mental health disorder or illness which is disrupting your life and causing you financial stress, you should look into disability benefit programs. Many federal, state, and local initiatives provide assistance and financial support to individuals with mental health disabilities.
Some of these programs include:
- The SSAs Old-Age, Survivors, and Disability Insurance program, which provides monthly benefits to qualified retired and disabled workers, as well as their dependents and families of insured workers
- State-specific programs, such as Michigans Disability Assistance Program , which provide cash assistance to eligible adults who are 65 years old or older and have a disability
- Medicaid Section 1115 Demonstration programs, which provide qualified Medicaid beneficiaries with substance use or mental health services
- Private disability programs, which assist commercial insurers. These are often included in an employers benefits package and are ideal for individuals with partial disabilities.
There are also many programs available that can help you through the disability benefits application process. Children or adults who are at risk of homelessness and have a severe mental illness, medical impairment, or co-occurring substance use disorder, for instance, may qualify for the SSI/SSDI Outreach, Access, and Recovery . Under this program, case managers work closely with eligible individuals to help them secure SSI and SSDI benefits.