What Medical Conditions Qualify for Long-term Disability

Long-term disability, also known as LTD, protects your income if a disability or illness has a significant effect on your health, so much so that it prevents you from completing the core functions of your work.

For such individuals, the Long term disability insurance claim provides financial benefits that can cover your income1 which is tolled by your disability. This only applies if your medical conditions qualify for long-term disability benefits or LTD.

So, today, we will discuss a few medical conditions that qualify for this benefit.

1. What is a Long-term Disability Benefit?

Disability benefit is an insurance policy that is categorized into two types: short-term disability and long-term disability. As the name goes, the short-term disability benefit is when you get the insurance for a shorter period.

Today, we will explore long-term disability benefits in more detail. Long-term disability insurance is provided when an illness or medical condition prevents a person from working for a longer period.

Unfortunately, while having a long-term disability, health insurance cannot always cover medicinal expenses and hospital. This, with out-of-pocket expenditure and uncovered services, can add up, making your financial implications even worse.

2. Medical Conditions that Qualify For Long-Term Disability | Ortiz Law Firm

According to the Ortiz Law Firm, various conditions qualify for benefits of long-term disability insurance2. These are again classified according to the disabled body part. Some of the common ones are mentioned below:

2.1. Musculoskeletal Disorders

MSDs are disorders concerned with muscles, bones, ligaments or tendons, and joints of the body not working properly. Severe chronic pain or inflammation in such areas can also be seen. Examples- are arthritis, fibromyalgia, tendinitis, and pelvic floor dysfunctions.

2.2. Neurological Disorders

These are medical conditions concerned with the neurological system that consists of the spinal cord, nerves running throughout the body, and the brain. Dysfunction in the nervous system causes such disorders—examples: amyotrophic lateral sclerosis3, epilepsy, Parkinson’s, Alzheimer’s, multiple sclerosis, and degenerative diseases4.

2.3. Mental Disorders

These mental health conditions change how the person perceives themselves, their thoughts, behaviour, and emotions in a way that is not good for their overall mental well-being. Examples: Post-traumatic stress disorder, anxiety, depression, bipolar disorder.

Cancer is an umbrella term for the uncontrolled growth of cells called tumors. These cells grow where they are not supposed to be or do not degenerate when they should. Examples: Malignant neoplastic diseases, breast cancer.

2.5. Special Senses and Speech Disorder

These are the disorders that cause impairment of the senses of the human body. This can especially cause significant interference in communication and interaction of the individual with others.

Creating a communication barrier among the people they interact with. Examples: Speech disorders, vision disorders like blindness or partial blindness, and hearing disorders.

2.6. Respiratory Disorders

These disorders are caused because of impairment in the respiratory system and its organs. These include the nasal path, lungs, bronchi and bronchioles, and alveoli.

These disorders mainly have a symptom of not being able to breathe properly. Examples: Asthma, pneumonia, Chronic Obstructive Pulmonary Disease (COPD), and asbestosis.

2.7. Cardiovascular and Circulatory Disorders

These disorders are caused by impairment in the circulatory system and its parts, including the heart and the blood vessels that carry the blood pumped by the heart. Examples: aneurysm of the Aorts or Major branches, Corpulmonale Secondary chronic pulmonary hypertension, Heart transplant, and Atrial fibrillation.

Partial List of Medical Conditions That Long-Term Disability Insurance May Cover

There are other common disorders like chronic illnesses, partial disability, totally disabled, physical injury, irritable bowel syndrome, and other illnesses that qualify for disability insurance policies.

3. What Does My Policy Cover?

Long Term Disability Insurance 101 (Long Term Disability Insurance 1/2)

Long-term disability policies and disability insurance companies primarily focus only on covering the income of the disabled person who may have been on stall due to their disability for a certain period.

4. How is Eligibility for Long-term Disability Determined?

4.1 The Definition of Disability

Though every policy’s definition of disability is different, there is a basic set that needs to be followed. The disability insurance company also needs to check you in for an insurance policy if you have multiple illnesses on a small level rather than a single illness that can significantly interfere with your job.

These insurance providers have a primary motive to help you maintain gainful employment.

5. When Do Long-Term Disability Policies Pay Benefits?

The time taken to approve your long-term disability benefits depends on various factors like the insurance company and their rules regarding the disability. However, the following are some of the steps that they must go through before providing you with long-term disability benefits. Most disability insurance claims to have their clients receive benefits well within 40-100 days.

There is a waiting period of around 30 days. Then, you are given time to provide your medical documents, and the request is reviewed. If the request is accepted, you will get your Social Security disability benefits right away.

6. Why Would Long-Term Disability be Denied?

The most common reason for which the insurance company denies long-term disability benefits is because the medical evidence is insufficient. The medical evidence provided must show that your disability is causing a hindrance in your day-to-day work life significantly.

Proper records mentioning the signs and symptoms of the condition should be in written form. It must ensure that the disability status and illnesses qualify for a Ltd claim.

7. Navigating the Long-Term Disability Claims Process Can Be Challenging

Photo by Scott Graham on Unsplash

There are times when qualifying conditions and long-term disability claims are wrongfully denied long-term disability benefits by the insurance company. You can refile your request with clearer and more detailed medical records at times like this.

Taking legal advice from an attorney can also be of help. An experienced disability attorney can guide and navigate you through the process of your long-term disability claim. You can appeal with additional evidence like medical reports to counter the denied benefits.

8. Long-Term Disability Due to Symptoms, Signs, and Subjective Conditions

Long-term disability claims can be challenging when the signs and symptoms are subjective. As it is difficult to measure and provide evidence. In these cases it is better to take the help of long-term disability attorneys to help claim disability benefits and prove your disability.

It is highly recommended to include testimonies from your friends and family about your medical conditions to the insurance provider with the help of a legal team.

Credible evidence about functional limitations caused by your disability 5and its impact on your daily life can be addressed. A deep and detailed description of your symptoms and their effects need to be mentioned.

9. How Long Will Your Medical Condition Be Covered?

This is also very subjective to the different insurance policy companies. Some of these cover a period of time, like 3-5 years, while others might even cover for a lifetime. This also depends upon how significantly your disability affects your overall performance at the workplace.

There is also your occupation policy, which approves benefits until you can perform your occupational duties without any hindrance. Unlike your occupation policy, all occupation policies will only consider your claims if you cannot work in the field of your skills at all.

10. Common Limitations and Exclusions

Though the insurance policy can help people a ton, there are limitations and exclusions to it. Some of them are mentioned below:

The waiting or elimination period, as discussed above, extends from 60 to 90 days, and this might make the client’s financial condition worse. It is necessary to get past this initial period that starts at the onset of the disability. This period can be recorded and used to prove your medical condition and its repercussions while filing to the insurance company.

Many people think that the insurance provider also pays benefits, including medical and treatment expenses, but this is not true. The benefit is only to cover the income of the disabled person.

One of the exclusions is when the client is not cooperative and is not ready to go further with the treatment plans or rehabilitation rehabilitation. In such cases, the application can be denied.

11. I Was Approved for Social Security Disability, but My Long Term Disability Claim Was Terminated

Social Security disability benefits and long-term disability benefits tend to have different eligibility criteria. That can be the reason for the acceptance of one and the termination of the other.

To get back to it you can review your termination letter or notice for the reason of termination and understand it better. An experienced attorney in the field of SSD and LTD can help you figure out where you missed out on the opportunity. They will guide you through the eligibility criteria for both.

12. Objective Evidence to Support a Long-Term Disability Claim

12.1 Why Objective Evidence is Needed

Objective evidence is far easier to present in the request than subjective evidence. It is needed because they are tangible and measurable and hence it is easier to understand the state of difficulty you face.

Also, having more objective evidence will increase your chances of getting accepted for LTD benefits. Some of the objective evidence for your disability6 can be:

12.2 Medical Records:

These can include the doctor’s notes, prescription, and diagnosis, along with the tests, laboratory reports, and test results. Anything that hint at the severity of the condition can be added to provide evidence for the disability.

The doctor’s testimony can also be submitted. You can ask a trusted medical professional to make an official medical report stating your condition’s symptoms, signs, and complications. This can also include what you are not mentally and physically capable of. The limitations that might affect your work-life situation can also be mentioned.

If anything can be shown through scans, it must be added. MRI, CT, and X-ray scans are some that can be taken to prove your condition. These can be visual evidence of bodily abnormalities or injuries to claim the impairments.

12.3 Functional Capacity Evaluation:

The FCE test assesses an individual’s physical capacity in terms of strength, endurance, and flexibility. If your medical condition affects these elements, you can also include a copy of the test result in your application.

Downlisted are some of the available long-term disability benefits insurance companies. This is not a promotion to any of these. It’s just data collected for your help.

  1. Assurity- It has an elimination period of 40- one year. The disability benefit period can extend from a few years to retirement.
  2.  Max Life Insurance: This is a short-term disability and long-term disability benefits insurance company in India. It provides financial protection and replaces the income source. It also focuses on recovery and offers other benefits, like tax savings. It has good customer care services that will guide you through the process.
  1. Couch, Kenneth A., et al. “Economic and health implications of long-term unemployment: Earnings, disability benefits, and mortality.” New Analyses of Worker Well-Being. Emerald Group Publishing Limited, 2014. 259-305. ↩︎
  2. Anand, Priyanka, and David Wittenburg. “An analysis of private long-term disability insurance access, cost, and trends.” Monthly Lab. Rev. 140 (2017): 1. ↩︎
  3. Kiernan, Matthew C., et al. “Amyotrophic lateral sclerosis.” The lancet 377.9769 (2011): 942-955. ↩︎
  4. Ames, Bruce N., Mark K. Shigenaga, and Tory M. Hagen. “Oxidants, antioxidants, and the degenerative diseases of aging.” Proceedings of the National Academy of Sciences 90.17 (1993): 7915-7922. ↩︎
  5. Ellcessor, Elizabeth. “Blurred lines: Accessibility, disability, and definitional limitations.” First Monday (2015). ↩︎
  6. Smith, Deirdre M. “Who Says You’re Disabled-The Role of Medical Evidence in the ADA Definition of Disability.” Tul. L. Rev. 82 (2007): 1. ↩︎

Last Updated on by Sathi Chakraborty, MSc Biology


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Sathi Chakraborty, MSc Biology

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