Common Types of Long-Term Disabilities: Do You Qualify?
Many employers provide long-term disability (LTD) policies to employees. These policies can help cover a portion of a person’s pre-disability earnings when they cannot work for an extended period due to a medical condition or injury.
Many medical conditions can interfere with a person’s ability to work. However, it is important to note that it is not the condition itself that qualifies a person for LTD benefits. Instead, it is how much that condition functionally impairs the individual that determines eligibility.
In this article, Chisholm Chisholm & Kilpatrick (CCK Law) will discuss:
- How a medical condition can qualify someone for LTD benefits
- Some of the most common medical conditions that prevent someone from working
- How to get long-term disability benefits for a qualifying condition
How Does a Medical Condition Qualify for LTD Benefits?
Eligibility for long-term disability benefits depends on a person’s policy. Each LTD insurance policy is different. It is important for all potential claimants to thoroughly read their policy before filing a claim, regardless of their profession.
The “definition of disability” is one of the most important parts of a long-term disability insurance policy. There are typically two definitions claimants will encounter: “own occupation” and “any occupation.” All claimants must provide evidence that they meet the applicable definition in their policy.
For example, if they have an own occupation definition, then they must prove they cannot perform their own profession. However, if they have an any occupation definition, then they must prove they cannot perform any job whatsoever. Read our in-depth article on the definition of disability for more information.
Therefore, for a medical condition to qualify a person for LTD benefits, it must render the person unable to work under the terms of their specific policy.
Common Disabilities and Long-Term Disability Coverage
As mentioned, several conditions may be more likely to qualify an individual for long-term disability benefits. Below are some of the most common medical conditions that can appear in successful claims for LTD benefits.
Cancers
Cancer is an uncontrolled growth or production of abnormal cells in the body that invade healthy tissues and organs. Many types of cancer may qualify a person for long-term disability benefits. Cancers that might qualify include:
Autoimmune Disorders
An autoimmune disorder is a condition in which a person’s immune system—which protects a person from foreign viruses and infections—mistakes its own tissue as foreign. When this occurs, the immune system will attack its own healthy tissue and damage the body. Examples of autoimmune disorders that might interfere with job duties enough to create eligibility for LTD benefits include:
- Multiple sclerosis
- Lupus
- Rheumatoid arthritis
- Crohn’s disease
- Ulcerative colitis
- Guillain-Barre syndrome
- Diabetes
- HIV/AIDS
- Sarcoidosis
- Thyroid disorders
- Hepatitis
Neurological Disorders
A neurological disorder is a disease of the central and peripheral nervous system, which includes the brain, spinal cord, nerves, and muscles. Neurological disorders that may lead to eligibility for LTD benefits include:
- Alzheimer’s disease
- ALS
- Dementia
- Epilepsy
- Non-epileptic seizures
- Bell’s palsy
- Restless legs syndrome
- Parkinson’s disease
- Fibromyalgia
- Stroke
- Migraines
- Peripheral neuropathy
- Carpal tunnel syndrome
- Meniere’s disease
- Lyme disease
- Huntington’s disease
Mental Illnesses
Mental health disorders are conditions that change mood, thought process, or behavior. Several mental health disorders may help qualify a person for long-term disability benefits. Examples of mental illnesses include:
Note: Many long-term disability policies have mental/nervous limitations. A policy that contains such a provision will limit benefits for a disability based on a mental health condition or nervous disorder—typically to 2 years or less.
Sleep Disorders
Several sleep disorders can make it impossible to work. These disorders affect how a person sleeps, which can lead to long-lasting symptoms such as chronic fatigue and diminished cognitive abilities. Examples of such conditions include:
Musculoskeletal Conditions
A musculoskeletal disorder is a condition that affects the bones, joints, muscles, tendons, ligaments, nerves, or other connective tissues. These conditions can make working impossible. Examples of such conditions that may lead to LTD benefits include:
- Herniated disc
- Sciatica
- Radiculopathy
- Degenerative disc disease (DDD)
- Osteoarthritis
- Spondylosis
- Scoliosis
- Spinal stenosis
- Osteoporosis
- IVDS (Intervertebral disc syndrome)
- Tendonitis
- De Quervain’s tenosynovitis
- Thoracic outlet syndrome
- CRPS
- Ankylosing spondylitis
- Orthopedic issues
Other Conditions
Some conditions not categorized above are also common in successful LTD claims. For example:
- Blood disorders
- Organ transplants
- Chemotherapy fatigue
- Skin disorders
- COVID-related symptoms
- Thrombophlebitis
- Lung disease
- Asthma
- COPD
- Irritable bowel syndrome (IBS)
- Chronic pain
- Kidney disease
- Cardiovascular disease
- Hypertension
- Genitourinary disorders
Getting Long-Term Disability Benefits When You Cannot Work
If a person has symptoms that qualify them for long-term disability insurance benefits, then they will have to submit a claim, including medical documentation, to their insurer. This documentation must prove that their condition meets their policy’s definition of disability.
However, frankly, our experience is that insurance companies do not want to approve an LTD claim if they can avoid it. Thus, many long-term disability claims are denied initially. While this may be discouraging, it is not the end of the road.
All LTD claimants have the right to file an appeal with their insurer to get benefits for their qualifying condition. It is important to read the insurance company’s denial letter thoroughly and directly address these issues in the appeal.
What About Short-Term Disability Benefits?
It is important to note that a disability does not have to be “permanent” to qualify for long-term disability benefits; it just needs to last longer than the benefit elimination period noted in the insurance policy. Yet, submitting a claim for short-term disability benefits may be more apropos in some instances.
Short-term disability (STD) benefits can protect a person’s income when they become unable to work, too. The key difference is that STD benefits typically offer only 3 to 6 months of coverage, with the longest benefit periods extending up to 12 months. In other words, short-term disability can provide benefits for disabilities that don’t last long enough to warrant long-term disability.
Thus, if a person suffers from a medical condition, like the ones mentioned above, that will only disable them for between three and six months, then short-term disability benefits may be more relevant to their situation. Likewise, STD benefits can also help protect a person’s income during their LTD elimination period, since this period is typically around three to six months.
CCK Law Can Help You with Your LTD Claim
Getting long-term disability benefits can be challenging. When a medical condition impairs you and renders you unable to work, your LTD benefits should be available—but insurance companies frequently deny legitimate claims.
CCK Law understands these frustrations. We have been helping LTD claimants since 1999 get the benefits they need. Some of the ways we help our clients include:
- Collecting and submitting evidence
- Acting as a point of contact with the insurance company
- Tracking all filing deadlines
- Ensuring all claims are compliant with ERISA
- Litigating in court when necessary
- And more
If you need help with your long-term disability claim and or appeal, then CCK Law may be able to help. Call us today at (800) 544-9144 for a free case evaluation with a member of our team. We will analyze your case and see if we can assist.
