Whether you are applying for disability for the first time or have been previously denied, you are not alone. However, it can certainly feel that way trying to complete a long-term disability (LTD) application while struggling with pain, injury, or illness. Previously unsuccessful LTD applications do not necessarily reflect how sick or injured you are, nor do denials mean that future applications won’t be approved. Many applicants successfully meet long-term disability requirements after submitting follow-up applications with the help of a doctor specializing in their medical condition and a lawyer experienced in navigating the LTD system.
Long-term Disability Requirements
Long-term disability requirements include eligibility criteria based on your current job responsibilities, your vocational history, the details of your benefits plan, your medical history including the injury or illness affecting work, and your future medical prognosis.
Long-term Disability Basics
Long-term disability is provided by many employers through an insurance plan that covers workers if they experience an inability to work due to a medical condition. Depending on the plan, beneficiaries see up to 60% to 80% of their regular rate of pay replaced if they are unable to earn an income.
To determine eligibility, insurance companies will assess your medical condition and how it prevents you from completing the duties of your job. They’ll also consider how your condition is expected to improve over time and whether reasonable accommodations can be made by your employer to keep you on the job.
Your Work History
LTD is an employer-based benefit. Those employed in either a part or full-time job can be eligible for long-term disability depending on the details of their plan. Most plans have a waiting period before they become active. This is called an “elimination period,” and it is usually 3 to 6 months.
Your Disability or Injury History
Most LTD applicants will have previously applied for short-term disability or EI sickness benefits. In some cases, successful short-term disability or EI benefit applications can support your long-term disability application. Consider that: 1) Receiving short-term disability benefits does not automatically make you eligible for LTD; 2) A wrongfully denied short-term disability application does not disqualify you from receiving LTD benefits; and 3) Your short-term disability and your long-term disability doctor may not be the same.
In fact, insurance companies may request that you see a specialist in your condition and use it as an excuse not to award benefits. Ask your personal doctor about being referred to a specialist. You might explain to them that you are applying for LTD and need help with your application. They can help point you to a doctor specializing in your injury or illness.
Your Medical Condition and History
A medical evaluation will help determine the extent of your injury, illness, or condition and whether it qualifies you for disability benefits. Qualifying conditions can include physical, cognitive, and emotional disabilities. Some receive benefits due to an acute illness or accident, while others may suffer from a worsening chronic condition that has become unmanageable.
The following is a non-exhaustive list of medical conditions that can qualify for LTD:
- Bipolar Disorder I and II
- Multiple Sclerosis
- Degenerative Disc Diseases
- Chronic Fatigue Syndrome
- Traumatic Brain Injury (TBI)
Your Policy Details
Most insurance plans distinguish between “any occupation” and “own occupation” benefits. Your policy makes one or the other available to you and in some cases, plans include both. These designations refer to the circumstances under which you’ll be considered eligible for benefits and what it means to be “totally disabled” and unable to work. Plans may use the “own-occupation” standard for the first two years and switch to the “any occupation” standard after that time.
“Own occupation” policies consider whether your condition prevents you from working at your preferred job. For example, a surgeon with an own occupation policy who needs their hands to work would receive benefits while recovering from a broken finger. Own occupation plans cover the surgeon unable to work in their chosen profession even if they could take a job in an alternative industry, such as babysitting or telemarketing, while they recover.
“Any occupation” insurance only provides coverage if your disability prevents you from meeting the responsibilities of any job due to injury or illness, regardless of your employment history. The standards of any occupation policies are often more difficult to meet because the person’s disability must affect a broader range of vocations. Some occupation-based insurance plans may still consider your employment history if the only jobs available represent a significant loss of income or responsibilities that depart significantly from previous work experience.
Both types of coverage provide similar payout even though the circumstances under which one is eligible are different. Each type of plan pays a percentage of your previous income, usually 60 to 80% of regular pay.