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      Covid-19, Disability

      PTSD After Working at a Hospital During COVID-19: Insurance Denied Disability Benefits

      Mental Health and Disability

      PTSD after Covid-19 can develop from the extremely stressful working conditions of our first responders and front-line hospital workers. Working at a hospital can be stressful enough. But, in the times of Covid-19 stressful working conditions cannot even describe what is going on for our first responders. Developing PTSD or any other mental health disease is understandable. Unfortunately, mental health disability claims are difficult to prove because mental health symptoms are not obvious and cannot be seen by others like physical injuries.

      The success of a disability claim for PTSD is dependent on many different factors such as when the symptoms first appeared, what was the triggering event, was the PTSD caused by a work-related event and how debilitating are the symptoms.

      PTSD disability claims are complex because of the nature of the illness and the many ways symptoms can be triggered.

      PTSD is a mental health illness that a person develops after having experienced trauma, including but not restricted to, sexual assault, bullying, domestic abuse, a car accident, war violence, workplace trauma, and even a natural disaster.

      People suffering from PTSD can display a wide range of symptoms such as flashbacks of the trauma, feelings of isolation or helplessness, anxiety, sleep disturbances, hyperarousal, and unhealthy isolation.  Unfortunately, many of these symptoms are self-reported and may not be fully documented by health care providers who leave disability claimants without adequate proof of their PTSD condition.

      PTSD and Insurance Companies

      Insurance companies rely on numerous arguments to deny PTSD disability claims because there are so many ways that PTSD can present which makes it difficult to prove someone actually has PTSD as opposed to another condition.

      In addition, some people are more at risk of developing PTSD symptoms than others.  That is to say in a group of people who experience the same traumatic event, only some people in the group will develop PTSD and experience symptoms.  Insurance companies sometimes delegitimize disability claims by taking the position that a claimant’s symptoms are exaggerated or overstated for the triggering event in question.

      Insurance companies can also deny disability claims if the claimant is eligible for workers’ compensation benefits and the insurance company can prove that the cause of the disability, in this case, PTSD, is work-related.  Disputes between claimants and insurance companies about how a claimant’s disability was caused are decided before the Workplace Safety and Insurance Appeals Tribunal (“WSIAT”) where workplace safety and insurance issues are adjudicated.

      Working During the Covid-19 Pandemic

      These types of disputes can pose problems for some people who made disability claims to their insurance companies for PTSD and worked in hospitals during the COVID-19 pandemic.

      If you are a hospital worker who is entitled to workers’ compensation benefits, specifically benefits from the Workplace Safety and Insurance Board (“WSIB”), and you worked in a hospital during the COVID-19 pandemic, an insurance company may take the position that the cause of your PTSD was work-related, given the horrific and at times traumatic events caused by the COVID-19 happening in hospitals during the pandemic.  This would mean that the insurance company could force you to seek compensation for your PTSD disability from WSIB by denying your claim and in some cases getting a decision from the WSIAT tribunal that you only have access to workers’ compensation benefits for your PTSD disability.  However, the insurance company would have to prove that your PTSD symptoms were directly as a result of your work activities and that your employment did not trigger an underlying PTSD diagnosis.

      If you worked in a hospital during the COVID-19 pandemic and are not entitled to workers’ compensation benefits, the insurance company cannot rely on the argument that the cause of your PTSD symptoms is work-related given your experience working during the COVID-19 to deny your claim. In this situation, the insurance company would have to resort to another argument to deny your claim.

      Getting Help is Important

      PTSD disability claims require early assistance from your health care providers and lawyer to ensure your symptoms are accurately presented to insurance companies.  As soon as you experience symptoms we recommend you seek medical attention immediately and if you are unable to work, we recommend you contact a disability claims lawyer to see you through making a claim and getting the compensation you deserve.

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