Life Insurance Claim Denied for PTSD

No life insurance claim should be denied for PTSD. If your life insurance claim was denied for PTSD contact us for representation and to get it paid.

1-888-428-4868

Post Traumatic Stress Disorder & Life Insurance Claims

PTSD, post-traumatic stress disorder is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event (according to the American Psychiatric Association, see Psychiatry,org).

For a life insurance claim to be denied for ptsd the insured has to have known that they were evaluated for, and diagnosed with, post-traumatic stress disorder by a qualified psychological professional. And then, not disclosed it on a life insurance application.

This rarely happens in the real world.

It’s not a regular practice for mental health professionals to label their patients. They intentionally avoid doing so. Their medical file, which they hold and control, may state a diagnosis of ptsd but they don’t share that with the patient. Instead, the patient believes they’re treating for sadness or depression or general stress.

Likewise, there is a specific evaluation-test that needs to be done before a clinical diagnosis of ptsd can be given. That testing, according to the National Institute for Mental Health, is:

To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:

At least one re-experiencing symptom
At least one avoidance symptom
At least two arousal and reactivity symptoms
At least two cognition and mood symptoms

Medical Records Used to Deny Life Insurance Claims for PTSD

What commonly happens is a medical treater will make a notation in a patient’s medical record and put a medical billing code in for ptsd — for their purposes, not the patient’s. When a life insurance claim examiner sees the medical billing code notation they assume the patient knew the notation existed and they deny the life insurance claim for having a material misrepresentation about their medical history. (See more about Material Misrepresentation in Life Insurance).

Not only is this unfair, it’s also not a basis for a legitimate claim denial.

When PTSD has been Diagnosed but Not Disclosed

Similarly not a basis for a legitimate life insurance claim denial is when someone has been diagnosed with ptsd but the severity is minimal or the treatment is moderate. Failing to disclose a diagnosis of ptsd on a life insurance application is not enough of a basis to have a death claim denied. There has to be a risk level that the insurer unknowingly accepted and the insurer has to be able to demonstrate that it was disadvantaged by insuring the person without knowing they had a ptsd diagnosis.

Post Traumatic Stress Disorder is Very Common

PTSD can occur in all people, of any ethnicity, nationality or culture, and at any age. PTSD affects approximately 3.5 percent of U.S. adults every year. The lifetime prevalence of PTSD in adolescents ages 13 -18 is 8%. An estimate one in 11 people will be diagnosed with PTSD in their lifetime. Women are twice as likely as men to have PTSD. Three ethnic groups – U.S. Latinos, African Americans, and Native Americans/Alaska Natives – are disproportionately affected and have higher rates of PTSD than non-Latino whites.

PTSD Rates in the Military

The statistics are quite varied but there’s no question military personnel have high rates of ptsd. Some studies estimate a rate as low as 7 percent while others are more than 30 percent. Anyone who has experienced combat is the most likely to have post-traumatic stress. Studies of Afghanistan and Iraq War veterans have shown that as many as 30 percent have developed PTSD. For veterans who saw combat, the risk of developing PTSD is even higher. The more tours made and the more combat experienced, the more likely it is that PTSD will appear.

One national life insurance company which targets military personnel for their policies uses PTSD as a common reason for claim denial. We uncovered that the insurer knows that up to 80 percent of military personnel that have seen combat will have ptsd. Yet, the insurer claims ignorance.

If they knew that 80 percent of their primary targeted policyholders had cancer they’d stop selling policies. What makes ptsd different than, say, cancer is that ptsd often goes undiagnosed for the patient whereas cancer never does. It’s an unfair practice the insurer uses but that we win against every time.

Who Is Qualified to Diagnose PTSD

The medical record of a general medical practitioner or anyone who is not a mental health professional who has experience helping people with PTSD — such as a psychiatrist, psychologist, or clinical social worker — is not qualified to give a diagnosis of post traumatic stress disorder. Therefore, the source of information the insurance company uses has to be verified as a qualified source of diagnosis.

This again goes back to the medical record of the insured and determining who made the notes about ptsd and what that person’s source of information was. Just as a plumber isn’t qualified to diagnose a tooth cavity, a general practitioner isn’t qualified to diagnose ptsd.

If a death claim is denied based on an unqualified ptsd diagnosis, it isn’t justified and can be overturned.

At The Center for Life Insurance Disputes we represent life insurance claim beneficiaries. Whether it’s a new claim to be filed, a delayed claim examination or a denied claim, we fight for our clients and get their claims paid.

Over $100 million recovered. Zero $0 money down.

Free consultation: 1-888-428-4868