Proving that you meet an insurer’s definition of a long-term disability is a major hurdle in qualifying for benefits. Often, the problem centers more on how a medical condition affects your ability to continue working rather than on a specific condition. For example, some insurers define a long-term disability as one that leaves you unable to continue in your current job for a specific time period while others define it as being unable to work at any job. Despite these differences, enough commonalities exist to form a general understanding of what types of disabilities qualify.
Disabilities covered by long-term insurance plans must typically meet two or three essential criteria. First, the condition must be one for which you receive medical treatment. Your doctor will usually need to provide a professional opinion about the nature and severity of your condition. You will also need to sign a release form giving the insurance company access to medical records such as examination findings, X-rays, lab results and surgical reports necessary to substantiate your claim. Finally, some insurers might reject a long-term disability claim if you are still on your employer's payroll.
Partial vs. Full Benefits
A condition that leaves you partially disabled may still qualify for long-term benefit payments. According to the U.S. Department of Labor, some plans allow for partial payments if you can perform at least one duty required in your current occupation on a part-time basis or perform duties that training, education or experience qualifies you to perform in another role. For example, a severe back injury may qualify as a partial disability if it means you can no longer drive a forklift, but can still operate a computerized inventory system.
Qualifying for Full Benefits
Long-term disability insurance typically covers 60 percent to 70 percent of your salary. In some cases payments can last throughout your working life. Because most insurers require that you also file for Social Security Disability when payments last indefinitely, the SSA’s impairment listing manual is a good tool for identifying disabilities covered in long-term disability plans. The manual lists a variety of conditions ranging from back injuries to cancer. The keys lie in how much the illness or condition affects your ability to work, and whether there is enough medical or diagnostic evidence to substantiate the disability claim.
Conditional Delays and Exclusions
According to Disability Secrets, a Nolo law website, most insurers will deny or delay payments for a long-term disability claim that relates to a pre-existing condition. A pre-existing condition is typically any illness or injury for which you receive treatment 90 to 180 days before a policy begins. For example, your policy might exclude payments for a pre-existing condition during the first 12 months after the policy is in effect. Many also delay payments for up to 24 months for disabilities connected to alcoholism, drug abuse or a mental or nervous condition.
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