Long-term disability (LTD) insurance exists to provide a financial safety net when you can’t work for an extended period. However, each policy has its fine print, and understanding exactly what your insurer expects can make all the difference in a successful LTD claim.
Before you begin the process, it helps to understand the requirements for long-term disability.
Every insurance policy has its own rules about what conditions qualify, how “disability” is defined, and what documentation you must submit.
The next step is learning how to apply for long-term disability. For this, you’ll need to coordinate with your doctors, gather medical records, and sometimes even complete detailed questionnaires about your daily activities and limitations.
Insurers may deny or delay benefits for reasons ranging from incomplete paperwork to questions about whether your condition truly meets their disability definition. That’s why it’s so important to build a strong case from day one and to know what to do if your claim is turned down. Our experienced Richmond SSDI lawyers can help!
Medical Eligibility: What Conditions Qualify for LTD Benefits
LTD benefits are intended for individuals who are unable to perform their jobs or, in some cases, any job due to illness or injury. So, to qualify for LTD benefits, you need to have a medical condition that seriously limits your ability to work.
But what kinds of conditions qualify? While it depends on your exact LTD insurance policy, some of the conditions that typically qualify for LTD benefits include:
- Chronic illnesses like cancer, lupus, or kidney disease.
- Serious injuries, such as a traumatic brain injury or spinal cord damage.
- Mental health disorders, including major depression, anxiety, or PTSD.
- Musculoskeletal problems, like severe back pain, arthritis, or fibromyalgia.
- Neurological conditions such as Parkinson’s disease, multiple sclerosis, or epilepsy
Understanding Your Policy’s Definition of ‘Disability’
Every insurance company writes its own rules about what “disabled” means, and those rules can vary a lot. Some policies use an “own occupation” definition. This means you may be eligible for benefits if your medical condition prevents you from doing the specific job you had before becoming disabled.
Other policies are more strict and use an “any occupation” definition. In this case, to receive benefits, you must prove that your condition keeps you from doing any type of work, not just your previous job, but any job you might be qualified for based on your education and experience.
Some LTD policies even switch definitions over time. A plan might start with an “own occupation” standard for the first 24 months and then transition to a “any occupation” standard after that.
If you’re unsure what your policy says or how to prove you meet the policy’s definition of disability, an experienced attorney can help break it down and ensure your claim aligns with the policy’s requirements.
Documentation Requirements for Long-Term Disability Claims
Insurance companies require solid proof before approving an LTD claim. To support your application, you’ll need:
Medical Records
You’ll need records from your doctors, hospitals, and specialists that show the history of your condition. The diagnoses, treatments, test results, progress notes, and any ongoing care.
A Statement From Your Treating Physician
A letter or form from your doctor explaining your condition, symptoms, and how they affect your ability to work carries a lot of weight. Be sure your doctor clearly states that you’re unable to perform your job duties (or any job duties, depending on your policy).
Functional Capacity Evaluations
Some claims benefit from a Residual Functional Capacity (RFC) assessment. This shows what you can and can’t do physically or mentally.
Job Description and Work History
Providing a formal job description, or even a personal account of your responsibilities, helps demonstrate why your condition prevents you from doing that work.
Common Reasons Long-Term Disability Claims Are Denied
Here are some of the most common reasons LTD claims are denied:
- Lack of Sufficient Medical Evidence: This is probably the common reason claims get denied. If your doctor didn’t include detailed records or didn’t clearly explain how your condition limits your ability to work, the insurer might say there’s not enough proof.
- Your Condition Doesn’t Meet the Policy’s Definition of Disability: If your situation doesn’t fit within your LTD’s policy definition exactly, your claim could be denied, even if you’re struggling.
- Inconsistent Information: Insurance companies will comb through your medical records, claim forms, and even your social media. If they find anything that doesn’t line up, it can seriously hurt your credibility.
- Missed Deadlines or Incomplete Paperwork: The LTD claims process comes with a mountain of forms, deadlines, and fine print. If you miss a deadline, forget to submit a form, or fail to complete something properly, your claim could be denied due to a technicality.
Tips for Filing a Successful LTD Claim or Appeal
Here are some tips to help you put together a strong LTD claim or appeal:
1. Don’t Wait Too Long
Insurance policies have strict deadlines. Missing one could result in an automatic denial, even if your case is strong. As soon as you realize your condition may prevent you from working long-term, start gathering information and reach out for help if needed.
2. Get Your Doctor on Board
Your doctor’s opinion carries a lot of weight. Make sure they understand the full picture of your limitations, including how your condition affects your ability to work. Ask them to document this in your records and on the relevant forms.
3. Be Consistent
One of the top reasons claims are denied is inconsistency between what you report, what your doctor says, and what’s in your medical records. Double-check your forms, letters, and statements. Everything should tell the same story.
4. Keep a Personal Health Journal
Writing down your symptoms, doctor visits, and how your condition affects daily tasks can be helpful. It adds a personal layer to your claim and can help jog your memory when filling out forms or discussing your case with your attorney.
5. Get Legal Help Early
LTD claims often involve numerous legal and medical technicalities. A small error can result in the loss of your benefits. Having an experienced LTD attorney by your side can increase your chances of a successful outcome.
Contact an Experienced Richmond SSDI Lawyer
Insurance companies don’t always make it easy to secure LTD benefits. They require detailed documentation, specific timelines, and strict proof that your condition meets their definition of “disability.” So, it’s worth being prepared and fully informed about how to claim long-term disability before submitting any paperwork.
If you have questions about the requirements for long-term disability, would like to learn more about how to claim long-term disability, or need assistance with a denied LTD claim, contact Hunter| Everage Injury and Disability Attorneys at 704-377-9157 to request a consultation.