Question: I suffer from panic attacks when I leave my house. It has gotten so bad, and I can no longer work. Could I qualify for long term disability benefits due to my agoraphobia?
Answer: Yes! Patients with agoraphobia may be unable to work because of their disease and its related complications. If so, they may qualify for long term disability (LTD) benefits.
What is Agoraphobia?
Agoraphobia is a debilitating anxiety disorder that causes extreme anxiety when in public places. “Agora” is the Greek word for public places. “Phobia” means fear of something. People usually develop Agoraphobia in their early adulthood. People develop not a fear of the places themselves but the feeling of being helpless, out of control, or trapped. This anxiety manifests into a major panic attack, resembling a heart attack, that can leave a person hospitalized.
Agoraphobia triggers anxiety in unfamiliar settings or places perceived to lack easy escape routes. Locations such as shopping malls, airports, and bridges are typical hotspots for agoraphobic episodes, especially in expansive areas or social contexts where the individual feels a loss of control.
The trigger for agoraphobia is widely felt to be a fear of public embarrassment. Most of the people who suffer from it are just as afraid of having a panic attack as they are of the settings that originally inspired them. A feeling of insecurity and disorientation can overtake an affected person when in uncomfortable situations, which cause increased anxiety. In severe cases, agoraphobic people may become too disturbed to ever leave their homes. This is why the disease is sometimes confused as a simple fear of crowds and public places.
The National Institute of Mental Health has calculated that around 3 million Americans between the ages of 18 and 54 have agoraphobia, and it is twice as likely to occur in women as men. It is assumed that people usually acquire this disease from experiencing an intense attack and fearing that one will occur again, causing avoidance of the place where it happened or anywhere similar. The illness can develop at any age but typically starts around 25.
Applying for Long Term Disability with Agoraphobia
You will need to obtain a copy of your long term disability policy and check to see what is covered. You can obtain a copy of your policy from your employer through the human resources department. It’s important to know that most group long term disability policies will only cover mental illnesses for up to two years.
Understand the Terms of Your Policy
Under the terms of most policies, the definition of disability changes after a certain time. During the initial period, your claim is reviewed under the “own occupation” definition of disability. This refers to being unable to work in your current occupation. During the continuation period, you will have to be disabled under the “any occupation” definition of disability, which is harder to prove.
There could be other policy limitations that impact your claim. Claims due to a mental illness are typically terminated after 24 months. We sometimes see policies that limit benefits for certain musculoskeletal disorders. Benefits will also end if you reach retirement age during the claim period.
Documenting Your Disability
In order to be approved for long term disability, you will need to provide your insurance company with documentation of your Agoraphobia. Your claims adjustor will need to see evidence from your doctor of:
- Panic attacks that cause extreme worry about another one.
- Disproportionate fear or anxiety about situations including being in open space, closed spaces, using public transportation, being in a line, etc.
- Your medical history including psychiatrist reports that support your diagnosis
Your claims adjustor will want reports from your doctors that outline your limitations. Normally these are physical limitations outlined in a residual functional capacity report, but in the case of mental illness your report my refer to your inability to:
- Understand and comprehend directions and information
- Interacting with co-workers or the public
- Adapting to changes
- Managing one’s own behaviors
- Concentrating and keeping pace with others
Do Not Resign Your Position
If your employer calls you and asks you for your resignation, consult a disability attorney before you do. When you use the term “resign,” you are telling your employer that you quit. Resigning your position is not the same as not being able to work your job due to your disability. This is why the correct language in your letter is so important. A best practice is to consult a disability attorney before you submit your letter to human resources.
Keep A Journal
Keeping a journal is important. This is your documentation during your claims process. Record every appointment, every symptom, how you feel daily, medications you are taking, and the side effects, and dates and times to speak with the insurance companies and doctors. When you need to refer back to something, it will be easy for you to look at your records.
Navigating Long-Term Disability Claims
Partnering with a disability attorney significantly increases your chances of securing the benefits you rightfully deserve due to agoraphobia. A previous denial of benefits doesn’t signal the end of your claim. In fact, it is a common experience for many long term disability claimants. However, you have the right to gather additional information to bolster your case and appeal the insurer’s decision.
Often, expert help makes the pivotal difference between approval or denial of your claim. The journey to obtain these benefits might seem overwhelming, but a knowledgeable disability attorney will be your compass, guiding you every step of the way. They operate on a contingency basis, meaning they’re only paid if they recover benefits for you.
Given the inherent challenges in establishing mental health claims, it’s prudent to engage a disability attorney if your claim has been denied. The Ortiz Law Firm has a proven track record of representing individuals in disability insurance cases nationwide. If you would like to talk to a qualified disability lawyer, please reach out to us at (888) 321-8131. We’re eager to assess your situation and guide you through the appeals process.