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?
Answer: Yes! Patients with agoraphobia may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their agoraphobia may qualify for long term disability (LTD) benefits. The insurance company will review their claim to see if they qualify under the conditions of that plan.
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. A panic attack is a short period of intensely heightened anxiety, characterized by chest pain, choking, dizziness, nausea, a racing heart, sweating, and trembling. They appear at moments of incredible stress.
Agoraphobia specifically causes anxiety in environments that are not familiar or which are thought to have no easy escape. Places like shopping malls, airports, or bridges are common areas for an agoraphobic attack, which are most likely to occur in wide-open spaces or social situations in which the person has no 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
Check Your Policy
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 Structure of Your Policy
Two types of periods govern most policies. The initial period (the first 24 months) and the continuation period (after the first 24 months). During the initial period, you will be disabled under “own occupation.” This refers to being unable to work in your current occupation. During the continuation period, you will have to be disabled under “any occupation,” which is just harder to prove than the initial “own occupation.” Claims that are considered a mental illness are terminated after 24 months with no continuation period. Benefits will also end if you reach retirement age during the claim period.
Documentation for Long Term Disability Claim
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 like:
- Panic attacks that cause extreme worry about another one.
- Disportionate 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.
Qualifying for Long Term Disability
Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve for your agoraphobia. Even if you have been denied benefits, that does not mean your fight is over. Many people are denied benefits the first time they apply. You have the right to file an appeal and try to get more information that may help your case. Getting expert help is often the difference between being denied and being approved for benefits.
While the process can be daunting, your experienced disability attorney will be able to guide you through the process. They do not get paid until you win your case. You can seek help without worrying about upfront costs or unexpected bills.
Since proving mental illness claims can be tough, it’s smart to consult a disability attorney early in the claims process. An experienced disability attorney can help you stay on top of your deadlines, help you gather your documents, assist you during field interviews, and give you guidance that will help you get your claim approved. The Ortiz Law Firm has successfully represented people in disability cases across the United States. If you would like to talk to an experienced disability lawyer about your agoraphobia and its impact on your ability to work, call us at (888) 321-8131. We would be happy to evaluate your case and to discuss how to help you through the appeal process.