Applying for Long Term Disability

Applying for long term disability benefits is much different than applying for Social Security disability. If you have long term disability insurance available and have incurred a disability that is thought to be permanent or long-term and restricts your ability to work, then applying for long-term disability insurance is within your best interest. Below, we discuss the process of applying for long term disability benefits and why having the right attorney is critical.

What is long-term disability insurance?

Long-term disability coverage, or LTD coverage, is a type of insurance coverage generally offered to an employee by an employer. The first thing to understand is that not all employers carry LTD coverage; the law does not require them to do so. However, if your employer does carry LTD coverage, then it covers a wide array of disabilities, not just those incurred during a work-related injury/task. You gain coverage for LTD insurance by paying a monthly premium amount. Some employers provide LTD insurance policies for free. Employer provided insurance is typically considered an ERISA LTD policy.

You can also purchase long term disability insurance individually. This is called an individual LTD policy or a private LTD policy.

LTD insurance coverage will help replace part of your income during the period that you are disabled. Usually, this amount is approximately 60 percent of your salary.

Steps in applying for long term disability benefits

If you have long-term disability insurance and recently had an accident that left you disabled, you’ll need to file an application to recover your benefit amount. The sooner that you start applying for long term disability, the more ready you’ll be when it’s time to file. To help you get started, here are some steps to follow when applying for long term disability benefits:

  1. Hire an Attorney: The very first step, following your disability and seeking medical care, is to hire a long term disability attorney who can guide you through the application process improves your chances of your claim being approved. You should consider hiring an attorney the minute when you become disabled. An attorney can walk you through your application step-by-step and ensure that you have all of the documentation and evidence required. Applying for long term disability benefits without an attorney is not advised.
  2. Notify Your Employer: The next step is to notify your employer of the fact that you’ll be unable to return to work (either temporarily or permanently) due to the disability. You may be eligible for temporary leave under the FMLA (Family and Medical Leave Act). You also should inform your employer that you plan on applying for long term disability. Some insurance companies require employers to submit an employer statement. If your insurance company requires this, make sure you ask your employer to submit one.
  3. Review Your Policy’s Time Limits: The third thing that you’ll want to do is to review your insurance policy’s time limits for filing an application for long-term disability insurance. If you are not applying for long term disability benefits within the required time frame, then there’s a chance that your benefits will be denied.
  4. Review Your Policy’s Definition of a Disability: The fourth item of business to take care of is reading through your policy thoroughly to learn your insurance company’s definition of disability. Some policies may require a person to be fully disabled before LTD benefits can be paid. Others will require the applicant to be only partially disabled. Learn exactly what your policy says about how it defines disability and make sure that your disability meets that criteria.
  5. Filing an Employee Statement: The application process for LTD benefits will vary slightly, depending upon your insurance company. However, most insurance companies will require you to file an employee statement. The employee statement will include the basis of your information, place of work, primary care physician, medical information, any workers’ compensation information and more. It is important that you file your employee statement within the time limits discussed above.
  6. Seek Medical Care and Gather Medical Evidence: You should apply for LTD benefits as soon as you and your doctor determine your disability to be severe enough to prevent you from working. Usually, this is within three months or less of when you stop working. Gathering medical evidence is one of the most important parts of your LTD application. If the medical evidence is not sufficient enough to substantiate your disability, then it is highly likely that your application will be denied. When meeting with your medical professional, explain your situation to him or her. Your doctor will need to submit evidence that not only speaks to the severity of your condition, but also details why your condition prevents you from returning to work.
  7. Think About Your Other Benefit Options: Long-term disability insurance is not your only benefit option. In fact, the insurance company may require you to apply for other sources of disability income. Two sources that you should start thinking about now are Social Security disability benefits (either Social Security Disability Insurance or Supplemental Security Income) and workers’ compensation. The latter only applies if your disability was caused by a work-related activity.

Image: Steps in Applying for Long Term Disability Benefits

How do you prove you are disabled when applying for long term disability?

Proving that you are disabled is the most important part of applying for LTD benefits. Depending upon your individual policy, you may have to prove that you are totally disabled. However, some policies only have a partial disability requirement. As such, you must meet your policy’s definition of disability. If you don’t, then your LTD application will be denied.

In order to prove that you meet your insurance policy’s definition of disabled, you will need to submit medical evidence. If the medical evidence is insufficient, then your claim will likely be denied.

What medical evidence is required when applying for LTD benefits?

The medical evidence required to substantiate your claim is often complex. For example, you will need to receive frequent and long-term care. If you’re not, the insurance company may not believe that your disability is severe enough to qualify for LTD benefits.

You’ll need to make sure that your insurance company receives all of your medical records. If any medical records are missing — even those from before your disability was incurred — your claim may be denied.

Finally, you will need a doctor’s statement that speaks the validity of your disability. The statement should indicate your limitations, specifically in regard to your work-related tasks.

Applying for long term disability benefits in a timely manner

Most LTD insurance policies come with a stipulation that a claim for LTD benefits must be filed within a certain amount of time. If your claim is denied, then there is also a time limit for which you must file an appeal (typically 180 days, although this varies by policy). If you don’t file your policy or appeal within the required time-frame, then you may forfeit your right to benefits and the right to sue your insurer.

Do I need an attorney to apply for long term disability benefits?

Ensuring that your application is complete when applying for LTD insurance is extremely important. To make sure that you have all the evidence necessary to substantiate your claim, you need the help of an attorney.

Once your application is filed, there may be other requirements you must fulfill before your benefits will start. For example, most LTD insurers will require you to apply for Social Security disability benefits to offset your LTD benefits. An attorney can help you understand this requirement and how to satisfy it.