Overview
Has Your Insurer Denied Your PTSD Claim?
A denial can feel overwhelming, especially when you are already trying to manage symptoms and treatment. Some PTSD claims are denied at the application stage. Others are terminated after an insurer review, an independent medical examination request, or when LTD shifts from an “own occupation” test to an “any occupation” test.
In many cases, a denial reflects the insurer’s view of the documentation, not the legitimacy of PTSD. Timelines can be strict, so it is important to act quickly after receiving a denial or termination letter.
Common Reasons Insurers Deny PTSD Claims
The insurer says there is not enough medical information, or clinical notes lack detail
Medical information was not submitted by the insurer’s deadline
Gaps in treatment or inconsistent follow-up
The insurer argues you are not receiving “appropriate treatment” or are not being treated by the “appropriate” provider
Records do not clearly connect symptoms to job-related restrictions
The insurer claims you can return to work with accommodations, or in an alternate role
The insurer relies on perceived inconsistencies between symptoms and daily activities
The insurer says there are no medically supported restrictions or limitations
The Aaron Waxman Difference
How Can Aaron Waxman and Associates, P.C. Help?
If your insurer denied your STD or LTD claim for PTSD, Aaron Waxman and Associates, P.C. can help you understand your options and build a stronger case. This may include reviewing denial letters, identifying evidence gaps, organizing a treatment timeline, and helping present your functional restrictions in practical work-related terms.
If you are looking for a disability lawyer to review a denied claim, we can discuss next steps and explain what options may be available.
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We take the time to understand what you are facing, then build a plan that protects your rights and supports your next steps.
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We take on insurer and employer pushback, manage deadlines, and keep your claim moving so you can focus on recovery and stability.
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Frequently Asked Questions
PTSD can occur after a person has been exposed to trauma, including situations where they believed their life was in danger or faced the threat of death or serious injury. Symptoms can continue long after the event and may affect how you think, feel, and respond to stress.
First responders and military personnel may be exposed to traumatic events through their work, which can increase risk. A person can also develop PTSD after a car accident, a traumatic workplace incident, or other traumatic events.
Symptoms vary, but may include:
- Nightmares or disturbing dreams
- Flashbacks or intrusive memories
- Anxiety or panic attacks
- Avoidance behaviours
- Mood changes, irritability, or feeling on edge
- Difficulty sleeping
- Difficulty concentrating or memory problems
PTSD is diagnosed by a qualified healthcare professional through clinical assessment. Diagnosis typically considers symptoms, duration, trauma history, and how the condition affects daily functioning. For disability claims, documentation often needs to describe symptom severity, treatment plan, and work-related restrictions over time.
Yes. PTSD symptoms can affect reliability, concentration, judgment, and stress tolerance. Many claims focus on whether symptoms prevent you from performing your job consistently and safely, including meeting deadlines, managing workplace stress, interacting with others, or maintaining regular attendance.
PTSD can be recognized as a disability when symptoms and functional limitations prevent you from working and the medical evidence supports those restrictions.
Depending on your circumstances, benefits may include:
- Employment Insurance (EI) sickness benefits
- Short-term disability (STD)
- Long-term disability (LTD)
- CPP Disability
Other programs may apply in some situations depending on eligibility and policy coverage.
PTSD claims can be more complex because symptoms may fluctuate and may be difficult to measure with objective testing. Insurers often request detailed medical records and may challenge whether limitations are severe enough to prevent work. Consistent treatment records and clear descriptions of functional impairment are often critical.
Yes. If your PTSD STD or LTD claim was denied, or your benefits were terminated, you may be able to challenge the insurer’s decision. Many denials come down to alleged evidence gaps, not the reality of your condition. Strengthening documentation, clarifying work restrictions, and responding directly to the insurer’s stated reasons can improve your position.