How to File a Long-Term Disability Claim

Facing a long-term illness or injury can be scary, especially if it keeps you from working full-time and earning an income. Thankfully, long-term disability (LTD) insurance is a safety net available to many working Americans.

Filing for LTD benefits may take time and effort. This guide will help you understand the essentials of filing for long-term disability benefits, so you can confidently find resources as you navigate the process.

Each disability policy has its own requirements and deadlines, so familiarizing yourself with your insurance coverage and plan documents can make all the difference if you ever need to file an LTD claim.

What is Long-Term Disability Insurance?

Whether you’re covered by an individual LTD policy or you have employee benefits, understanding the specifics of your coverage is critical to a successful claims process.

Long-term disability insurance, or LTD insurance, is a type of insurance plan that provides financial protection to individuals who can’t work due to a disability, illness, or injury.

LTD insurance offers a monthly benefit payment that replaces some or all of your lost income. It helps cover essential expenses while you’re out of work and often continues your health insurance to minimize out-of-pocket medical expenses.

You must meet certain criteria the insurance company sets to be eligible for long-term disability insurance. These criteria typically include the following:

  • Qualifying condition: You must have medical conditions, injuries, or illnesses that prevent you from performing your current job or any other occupation.
  • Waiting period: You may need to complete a waiting period, also known as an elimination period, before becoming eligible for benefits.
  • Diminished capacity: Long-term disability coverage has two main categories of coverage. “Own occupation” coverage takes effect when your disability hinders you from meeting the requirements of your current role. “Any occupation” coverage only applies when you can’t perform any job you could reasonably fulfill.

Reviewing your specific insurance policy to understand the exact coverage and eligibility criteria it outlines is important.

Types of Disabilities Covered

Long-term disability insurance typically covers a wide range of disabilities, including but not limited to:

  • Musculoskeletal disorders
  • Special senses and speech
  • Respiratory disorders
  • Cardiovascular system
  • Digestive system
  • Genitourinary disorders
  • Hematological disorders
  • Skin disorders
  • Endocrine disorders
  • Congenital disorders that affect multiple body symptoms
  • Neurological disorders
  • Mental disorders
  • Cancer
  • Immune system disorders

Each insurance policy may have its own list of covered disabilities, so reviewing your policy for specific details is crucial. You can consult the Social Security Administration’s (SSA) list of adult disabilities and your plan documents to determine if you have a qualifying disability.

You need a strong understanding of your long-term disability insurance to file a claim.

Because private disability insurance plans operate differently, you’ll want to familiarize yourself with your coverage, eligibility criteria, and the types of disabilities covered, so you can make informed decisions and navigate the application process effectively.

How to File for Long-Term Disability Benefits

When it comes to filing a long-term disability claim, there are several crucial steps you need to take. From contacting the insurance company to providing medical evidence, each stage plays a vital role in the success of your claim.

Following these steps carefully can ease the long-term disability application process.

  1. Contact the Insurance Company
  2. Complete Claim Forms
  3. Provide Medical Evidence
  4. Review & Evaluation Process
  5. Independent Medical Examination
  6. Appeals & Reconsideration

1. Contact the Insurance Company

The first step in filing a long-term disability claim is contacting your insurance company.

You can do this by phone or in writing, providing them with the necessary information about your current health status. It’s important to document all the communications you have with your insurance carrier.

2. Complete Claim Forms

After you contact the insurance company, they’ll send you the necessary claim forms. These forms typically require information about your medical condition, employment history, and supporting documentation. Take your time to fill out these forms correctly and make sure you provide all the necessary details.

You may need to submit an employee’s statement or ask your HR department to submit an employer statement on your behalf.

Filing for long-term disability benefits requires careful attention to detail and timely submission of necessary forms.

3. Provide Medical Evidence

One of the most crucial aspects of a long-term disability claim is providing medical evidence to support your case.

Medical evidence can include medical records, test results, physicians’ statements, and other relevant documentation. It’s essential to gather all the necessary evidence and submit it along with your claim forms to strengthen your case.

By contacting the insurance company, completing claim forms accurately, and providing comprehensive medical evidence, you can be sure you’re filing your long-term disability claim effectively.

Remember to adhere to the specified time limits to ensure your chances of a successful claim.

4. Review and Evaluation Process

Once you’ve submitted your long-term disability claim, the insurance company will initiate the initial review and evaluation process. During this stage, the claims department will carefully assess your provided information.

The initial review aims to determine if you meet the basic eligibility criteria for long-term disability benefits. This evaluation establishes if your medical condition prevents you from performing your job effectively and if it qualifies as a disability under the terms of your policy.

If your policy requires it, you may also need to be approved for SSDI at this stage.

5. Independent Medical Examination (IME)

Sometimes, the insurance company will request an Independent Medical Examination (IME) to evaluate your condition further. An IME is an examination by a healthcare professional chosen by the insurance company.

The IME is designed to present an unbiased opinion regarding your medical condition and its impact on your ability to work. If needed, the examining physician will thoroughly evaluate your medical records, conduct a physical examination, and prepare a report with their findings. This report will play a crucial role in determining the outcome of your claim.

6. Appeals and Reconsideration

You have the right to appeal the decision if the insurance company or SSA denies your initial claim. The appeals process provides an opportunity to present additional evidence or clarify any misunderstandings that may have occurred during the initial review.

If you file an appeal, carefully review the denial letter and the reasons for the rejection. You can then gather additional medical records, expert opinions, or other relevant documentation supporting your claim. Presenting a strong case during appeals is crucial to increasing your chances of a successful outcome.

The insurance company will thoroughly review all the information and evidence provided during the appeal process. Based on the updated information, they’ll reassess your claim and make a final determination.

Remember that the claim review process can be complex and time-consuming. It is advisable to seek legal advice or assistance from an experienced long-term disability attorney who can guide you through the process and help you present a compelling case.

3 Tips to Win a Long-Term Disability Claim

If you’re filing for long-term disability, following these guidelines can increase your chances of a successful claim.

Be Honest and Accurate

One of the most crucial factors in a long-term disability claim is honesty. It’s important to provide accurate information throughout the entire process. Disclosing your medical history, symptoms, and limitations will reduce questions and follow-ups.

Any inconsistencies or false statements may jeopardize your claim and could lead to denial. You can establish credibility and build a stronger case by being honest from the start.

Seek Medical Support

Treating physicians and healthcare providers are crucial in documenting your condition, limitations, and prognosis.

Communicate with them openly and regularly about your symptoms, treatment plans, and progress so they can document as much as possible for you.

Their medical records and expert opinions will provide substantial evidence to support your claim. It can also be beneficial to obtain a comprehensive medical report that outlines your impairments and their impact on your daily life.

Keep Documentation Organized

Organizing your documentation is key to a successful long-term disability claim. Create a system to store and categorize all the relevant paperwork, such as medical records, test results, doctor’s notes, and correspondence with insurance providers.

You can opt for digital storage solutions, such as an external hard drive or Cloud Server, or you can be more traditional with hard copies.

Keeping everything organized will help you easily locate and present the necessary documents when required. Strong organization saves time and demonstrates your preparedness and attention to detail.

Following these tips can enhance your chances of a successful long-term disability claim. Honesty, medical support, and organized documentation are crucial to building a strong case.

What is the Difference Between SSDI and SSI?

Taxpayers fund Social Security Disability Benefits, but not all programs are created equally.

Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are two of the most common programs the SSA offers. SSDI supports American taxpayers with a qualifying disability and a proven work history, while SSI is available to Americans at any age.

SSI provides minimal supplement income to people with disabilities who otherwise wouldn’t have the resources or finances necessary to meet their needs. SSDI has work history requirements, so it’s typically reserved for people with a qualifying disability that impedes their ability to work in any capacity.

There are a lot of nuanced differences between the two programs, including eligibility, the time it takes to qualify, and the benefit amount you can expect. For this article’s sake, we’ll focus on SSDI and how it works with private and employer-provided disability insurance.

Can You Collect Private Disability and Social Security at the Same Time?

Yes, you can collect private disability and social security at the same time. Some long-term disability plans require you to qualify for SSDI before receiving LTD benefits.

However, SSDI does not require you to file an insurance claim with a private carrier.

If you’re planning to collect private disability and SSDI, your insurance carrier may reduce your benefit amount to account for the SSDI income you’re bringing in.

Every insurance company is different, so asking questions is important to avoid ambiguity and confusion.

Frequently Asked Questions

What is the average time it takes to get approved for disability benefits?

The SSA reports that it can take three to five months to receive a decision on your LTD application, but the exact processing time depends on your medical records and any other evidence you’ve provided.

You can also use short-term disability benefits while you wait for your claim to be processed.

How much does disability pay?

Each state calculates disability pay differently, but you can check your SSDI payment amount online anytime. mySocialSecurity allows you to create an account with your personal information.

After you’ve created an account, you can look at your income history, work credits, and retirement plan benefits. If you notice any inaccuracies, you can correct them and potentially increase your monthly benefit amount.

What is ERISA, and what does it do?

The Employee Retirement Income Security Act (ERISA) establishes the minimum requirements employers must provide to eligible employees. ERISA encapsulates many employee-sponsored benefits, including 401(k)s, pensions, health savings accounts, life insurance, and disability insurance benefits.

If you’re employed, we recommend contacting your employer’s human resources department to familiarize yourself with your benefits and address any lingering questions.

What is the most approved disability?

According to the SSA, arthritis and musculoskeletal disorders are among the most approved disabilities. Multiple sclerosis (MS) and cancer have the highest approval rate for initial LTD applications at 64–68%, but respiratory disorders and joint disease carry the next highest approval rate at 40–47%.

People who file with assistance from a lawyer are the most likely to be approved for disability benefits. We recommend appealing if you’re denied coverage after your initial LTD application.

What is the five-year rule for Social Security disability?

The five-year rule for Social Security disability waives the initial waiting period for people approved for disability, stopped collecting benefits, and became unable to work within five years.

If you have collected SSDI within five years and need to reapply, you will likely have a smoother claims process.

Final Thoughts on Filing for Long Term Disability Benefits

Filing for long-term disability is a long and winding road, whether you’re using private insurance or going through SSA.

Utilizing the SDI Online platform can expedite the submission process. If you haven’t fully recovered and wish to extend your benefit period, ensure your physician or practitioner completes the Physician/Practitioner’s Supplementary Certificate (DE 2525XX) and submits it online or by mail.

On the other hand, if you’ve recovered or returned to work, no further action is needed to halt your claim. However, if you have a relapse, promptly file a new claim form (DE 2501) and report your work dates.

It’s important to understand the specific procedures and requirements to maintain your long-term disability benefits. We recommend consulting your financial advisor or a qualified legal representative to ensure you can access your maximum LTD benefits.