Over 50 Years of Combined Experience Against Insurer Denial
PTSD Disability Lawyer Calgary
The insurer said you can work. You know otherwise.
- Living with post-traumatic stress disorder that prevents you from returning to work?
- Submitted a long-term disability claim and received a denial letter?
- Benefits were approved, then terminated once the insurer re-evaluated your file?
Insurers aggressively dispute PTSD claims because they lack objective test results. Whether you are wondering if PTSD qualifies as a disability or have already received a denial, we understand these disputes from the inside out.
Same-day response on business day inquiries.
PTSD files are judged on consistency long before compassion enters the room.
Because PTSD claims often lack objective test results, insurers frequently dispute them. Having assessed claims from within a national insurance provider, we understand these files from both sides. Our firm’s perspective is built on James’s 30 years of plaintiff litigation combined with Mark’s 20-year tenure as Senior Counsel for a major disability insurer.
Claim Files
Past results are not indicative of future results. The outcome of each case depends on its unique facts and circumstances.
Two Points Where PTSD Claims Are Denied or Cut Off
Post-traumatic stress disorder (PTSD) disability claims in Alberta tend to break down at one of two moments in the claim lifecycle. Knowing which one you are in shapes the entire litigation approach.
Denied at the Point
of Application
Initial denials often stem from how an insurer defines “disability.” Unlike a fracture, conditions like PTSD aren’t easily measured by standard tests, leading insurers to conclude that symptoms are insufficiently severe or treatment gaps exist.
Our review begins with the denial letter itself. The specific language an insurer uses reveals:
- Where they perceive your file to be weak.
- Procedural or interpretive errors made during the assessment.
- Specific grounds for a challenge in litigation.
Terminated at the Two-Year Definition Change
After two years, most policies shift the definition of disability. The question is no longer if you can perform your job, but whether you can perform any reasonably comparable occupation. Insurers use new assessments to justify terminating benefits.
This stage accounts for roughly 80% of our cases because it is where insurer errors accumulate. We investigate:
- Medical Interpretation: How they interpreted your records.
- Professional Selection: Which “independent” professionals they chose for the review.
- Policy Alignment: Whether the process followed strictly aligns with your policy terms.
Same-day response on business days.
How PTSD Symptoms Make the Claim More Complex
Seeking treatment after PTSD symptoms arise is important for both clinical reasons and how an insurer will assess the record.
- Nightmares and distressing dreams
- Re-experiencing the traumatic event
- Avoidance of trauma-connected situations
- Negative changes in mood and thinking
- Hyperarousal
- PTSD frequently co-occurs with other conditions, like depression and anxiety.
- The combination of PTSD and other conditions can worsen functional impairment, which affects the strength of a disability claim.
PTSD Symptoms Relevant to a Disability Claim
- Nightmares and distressing dreams
- Flashbacks and involuntary re-experiencing
- Hypervigilance and persistent alertness
- Difficulty concentrating
- Avoidance of trauma-connected environments
- Panic attacks
- Detached emotions and withdrawal
- Anger, guilt, and persistent negative emotional states
- Disrupted sleep and fatigue
- Suicidal thoughts and feelings requiring clinical management
The Documentation Gap
A PTSD diagnosis opens the door to a disability claim. What determines whether the file holds is the documentation connecting each symptom to a specific functional limitation and demonstrating why that limitation prevents sustained employment under the policy terms. PTSD frequently co-occurs with depression and anxiety, and each condition in that combination needs to be documented with the same precision the insurer will apply in disputing it.
From Denial Letter to Resolution
01
Initial Consultation
Your denial letter, policy, and medical history are reviewed to determine whether there is a viable case worth pursuing. We respond the same business day.
02
Document Collection
Your complete claim file is requested from the insurer, including internal decision records and the medical assessments they relied on.
03
File Review
We identify errors and improper assessments in how the insurer handled your claim. Insurers make mistakes: relying on assessments from non-physicians, misapplying policy provisions, disregarding your treating doctor’s findings. These errors can mean additional damages beyond reinstated benefits.
04
Statement of Claim
If the case proceeds, a lawsuit is filed to recover benefits and pursue additional damages for improper claims handling.
05
Discovery
Both sides exchange documents and conduct questioning. Independent medical examinations that contradict your treating physician are challenged at this stage.
06
Mediation
Most cases settle here. Approximately 80 percent resolve within 18 to 24 months. Settlement amounts depend on policy terms, benefit calculations, and insurer conduct.
07
Trial
If settlement is not reached, the case proceeds to trial. Outcomes depend on the specific facts, medical evidence, and policy language in your case.
We know how they think.
A formal PTSD diagnosis is the first step in a disability claim, but it doesn’t guarantee the outcome. The crucial factor is how effectively the file links each symptom to a specific inability to work, and whether the insurer followed the proper procedures in assessing your claim. This is where we begin our review.
Plaintiff Advocacy Meets Defence Intelligence
- Insight into how insurers build their denial positions
- Recognition of procedural errors other counsel may not identify
- Assessment of grounds for aggravated and punitive damages
In-Person Throughout Your Case
- Face-to-face meetings available at any stage of the file
- Same-day response to calls and emails on business days
- Serving Calgary, Alberta, and Saskatchewan
We Fight for the Full Value of Your Claim
- Review for aggravated, mental distress, and punitive damage grounds
- Prepared to proceed to trial if reinstatement of benefits requires it
- Your decision on resolution, made with complete information
PTSD Disability Claim FAQs
What PTSD symptoms matter in a disability claim?
The PTSD symptoms that bear on a claim are those interfering with sustained employment: nightmares, flashbacks, hypervigilance, difficulty concentrating, avoidance, panic attacks, emotional withdrawal, and disrupted sleep. PTSD also commonly occurs alongside depression and anxiety, and that combination affects how the file needs to be built. A post-traumatic stress disorder diagnosis documents the condition. The claim requires documentation connecting each symptom to a specific inability to work reliably.
Does PTSD qualify for disability benefits?
It can. PTSD is recognized as a disability in Canada, and where it significantly impairs a person’s ability to work, it may support a claim for long-term disability benefits under a private insurance policy. PTSD disability Canada claims are assessed against the specific language of the insurance contract, and what PTSD benefits Canada claimants consistently encounter is an insurer who accepts the diagnosis while disputing the degree of impairment. Is PTSD considered a disability under your policy? That requires reviewing the contract directly.
Can a PTSD claim be denied with a formal diagnosis?
Yes. A formal diagnosis is essential for applying, but it does not by itself satisfy the policy definition of disability. Insurers deny PTSD disability claims despite valid diagnoses by arguing the impairment level does not meet the policy threshold or that alternate work is available. Both grounds can be contested in litigation.
How long does a PTSD disability claim take?
Most cases settle within 18 to 24 months. Complex files or those requiring trial take longer. Reinstatement of ongoing benefits typically requires trial preparation rather than a negotiated lump sum.
What do I do when the insurer denies my PTSD claim?
A denied claim is not a closed one. We will review your file and tell you clearly what your options are.
Calgary-based Serving Alberta and Saskatchewan
Same-day response on business days
Past results are not indicative of future results. The outcome of each case depends on its unique facts and circumstances. This page is for informational purposes only and does not constitute legal advice.