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What Medical Conditions Qualify for Long-Term Disability?

Last Updated Date: Jul 10 2023 By Rich Frankel

Long-term disability (LTD) insurance coverage is typically offered by your employer as part of a compensation package, although you can also purchase a plan directly from an insurance broker.  LTD insurance protects you in the event of total or partial disability based on a qualifying condition through your policy. In short, if you are unable to work, your LTD insurer pays you benefits for a specific period or indefinitely, depending upon the terms of your coverage.

One key aspect of qualifying for LTD is proving that you are unable to perform daily activities and job functions as you normally would. However, working with a disability attorney can help you clear hurdles in the way of receiving benefits. He or she can also assist you in complying with waiting periods and other factors that determine your eligibility.

Proving Your Disability

The first step in filing an LTD claim is to understand the terms and conditions of your policy as they relate to your disability. Every insurer defines disability differently. The definition of each dictates the outcome of benefits you receive.

Insurance companies define permanent or total disability as being unable to work due to an injury or medical condition. Partial disability means that you may not be able to perform all of the duties of your job, or that you are unable to perform your work at the same level that you were at before your disability began. 

Proving your disability to your LTD insurance relies upon the reporting and opinion of your doctor. He or she provides a written statement that speaks to the seriousness of your condition. In addition to your doctor’s opinion, the claims adjuster wants to review clinical data that supports his or her determination. This type of data includes:

  •        Lab results
  •        Examination findings
  •        X-rays and MRIs
  •        Surgical reports
  •        Clinical Notes

Ongoing visits and care from your physician also speak to the long-term nature of your condition. Compliance with your doctor’s orders during this period is paramount to continue receiving benefits as most policies require you to be under the “active” care of a physician. Acting against medical advice could worsen your condition. LTD insurance companies are not willing to pay benefits if you could return to work with adequate treatment.  Regularly seeing your doctors and seeking all available treatment can be especially important for conditions that don’t have clear or obvious diagnostic “proof.”

Medical Conditions that Qualify for LTD

The medical conditions that may qualify you for LTD coverage vary. However, they must be severe enough to cause you to become unable to perform your occupation, and for some policies, any occupation if you continue to be disabled. Most LTD claimants do not attribute disability to a single illness or injury. Instead, it is generally a combination of factors that cause the body to break down.

Another complication in disability claims is that you may experience chronic pain, adverse reactions to medications, and fatigue. These elements combined can create a breeding ground for total disability. Insurance companies should consider the overall impact of your condition.

Since each condition carries its own symptoms, it’s essential to understand the impact your medical condition has on your daily life. Demonstrating how they affect your ability to work is critical.

There are a wide range of medical conditions, illnesses and disabilities that may qualify you for long-term disability benefits in New Jersey or Pennsylvania. Whether your medical condition qualifies for LTD coverage will depend on the policy or plan documents.  At Bross & Frankel, we have helped our clients obtain LTD benefits for conditions such as:

Musculoskeletal System Medical Conditions:

  •        Amputation
  •        Anterior Poliomyelitis
  •        Arthritis
  •        Back Pain
  •        Carpal Tunnel Syndrome
  •        Cervical Stenosis
  •        Chiari Malformation
  •        Degenerative Disc or Joint Diseases
  •        Dislocations and Fractures
  •        Fibromyalgia
  •        Herniated Disc
  •        Inflammatory Arthritis
  •        Lumbar Stenosis
  •        Mixed Connective Tissue Disease
  •        Muscular Dystrophy
  •        Osteoarthritis or Osteoporosis
  •        Reflex Sympathetic Disorder
  •        Rheumatism
  •        Rheumatoid Arthritis
  •        Ruptured Disc
  •        Sciatica
  •        Scoliosis
  •        Spine Disorders
  •        Tendonitis
  •        Undifferentiated Connective Tissue Disease

Nervous System Medical Conditions

  •        Alzheimer’s Disease
  •        Amyotrophic Lateral Sclerosis (ALS)
  •        Bell’s Palsy
  •        Cerebral Palsy
  •        Dystonia
  •        Empty Sella Syndrome
  •        Epilepsy
  •        Guillain-Barre Syndrome
  •        Meralgia Paresthetica
  •        Neuropathy
  •        Multiple Sclerosis (MS)
  •        Myasthenia Gravis
  •        Paralysis
  •        Parkinson’s Disease
  •        Seizure Disorder
  •        Syringomyelia
  •        Traumatic Brain Injury

Immune System Medical Conditions

  •        Chemical Sensitivity
  •        Immune Deficiency Disorders
  •        Lupus
  •        Poisoning
  •        Polymyositis
  •        Scleroderma

Psychological Medical Conditions

  •        Agoraphobia
  •        Attention Deficit Hyperactivity Disorder
  •        Anxiety Disorder
  •        Autism
  •        Bipolar Disorder
  •        Depression
  •        Drug Addiction
  •        Mood Disorder
  •        Obsessive-Compulsive Disorder
  •        Panic Attacks
  •        Post-Traumatic Stress Disorder
  •        Schizophrenia

Special Senses and Speech Medical Conditions

  •        Burns
  •        Eye Disorders
  •        Vision Loss
  •        Meniere’s Disease
  •        Otolaryngology
  •        Loss of Speech

Respiratory System

  •        Asthma
  •        Bronchiectasis
  •        Chronic Obstructive Pulmonary Disease (COPD)
  •        Chronic Restrictive Ventilatory Disease
  •        Cystic Fibrosis
  •        Emphysema
  •        Influenza
  •        Lung Transplant
  •        Mycobacterial, Mycotic, and Other Chronic Lung Infections
  •        Pneumonia
  •        Sarcoidosis

Cardiovascular and Circulatory System

  •        Aneurysm of the Aorta or Major Branches
  •        Chronic Venous Insufficiency
  •        Coronary Heart Disease
  •        Cor Pulmonale Secondary Chronic Pulmonary Hypertension
  •        Heart Attack
  •        Heart Failure
  •        Heart Transplant
  •        Hypertension
  •        Ischemic Heart Disease
  •        Left Ventricular Assist Device
  •        Peripheral Artery Disease (PAD)
  •        Phlebitis
  •        Recurrent Arrhythmia
  •        Symptomatic Congenital Heart Disease
  •        Stroke

Digestive System

  •        Cirrhosis
  •        Crohn’s Disease
  •        Colitis
  •        Diverticulitis
  •        Gastritis
  •        Gastroparesis
  •        Hernia
  •        Inflammatory Bowel Disease (IBD)
  •        Irritable Bowel Syndrome (IBS)
  •        Kidney Failure
  •        Liver Disease
  •        Primary Biliary Cirrhosis
  •        Primary Sclerosing Cholangitis
  •        Short Bowel Syndrome
  •        Temporomandibular Joint Disorder (TMJ)
  •        Ulcerative Colitis
  •        Wilson’s Disease

Infections and Parasitic Diseases

  •        Hepatitis
  •        HIV/AIDS
  •        Meningitis
  •        Polio
  •        Salmonella
  •        Tuberculosis
  •        Cervicitis
  •        Endometriosis
  •        Enlarged Prostate
  •        Interstitial Cystitis
  •        Kidney and Bladder Disorders
  •        Kidney Failure

Genital Organ Disorders

  •        Nephrotic Disorder
  •        Prostatitis
  •        Urinary Tract Infections
  •        Uterine Prolapse

Hematological Disorders

  •        Aplastic Anemia
  •        Chronic Anemia
  •        Chronic Granulocytopenia
  •        Sickle Cell Disease
  •        Chronic Thrombocytopenia
  •        Coagulation Defects and Hemophilia
  •        Hemochromatosis
  •        Liver Transplantation
  •        Multiple Myeloma
  •        Polycythemia Vera
  •        Spleen Diseases
  •        Systemic Vasculitis

Skin Disorders

  •        Bullous Diseases
  •        Burns
  •        Cellulitis
  •        Chronic Skin Diseases
  •        Dermatitis
  •        Dermatomyositis
  •        Eczema
  •        Genetic Photosensitivity Disorders
  •        Ichthyosis
  •        Psoriasis
  •        Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders
  •        Adrenal Gland Disorders
  •        Diabetes
  •        Gout
  •        Malnutrition
  •        Obesity
  •        Parathyroid Gland Disorders
  •        Pituitary Gland Disorders
  •        Thyroid Gland Disorder 

Multiple Body System Impairments

  •        Mosaic/Non-mosaic Down Syndrome
  •        Trisomy X Syndrome (XXX Syndrome)
  •        Fragile X Syndrome
  •        Phenylketonuria (PKU)
  •        Caudal Regression Syndrome
  •        Fetal Alcohol Syndrome

Cancer and Malignant Neoplastic Diseases

  •        Acute Leukemia
  •        Cancer, including Breast Cancer and Prostate Cancer
  •        Chronic Lymphocytic Leukemia
  •        Chronic Myelogenous Leukemia
  •        Hodgkin’s Disease
  •        Lymphoma
  •        Macroglobulinemia
  •        Mesothelioma
  •        Myelofibrosis
  •        Tumor

Significantly, this list of medical conditions that may qualify an individual for LTD benefits is not exhaustive — nor is it definitive.  Each insurance policy has its own coverage limitations and exclusions, which may include exclusions for pre-existing conditions. Our office offers disability claim reviews and assistance with LTD applications, to help individuals receive benefits under the policies.  We also appeal denials of LTD coverage, fighting on behalf of our clients to get them the benefits that they deserve.

Consider Working with a New Jersey Disability Attorney

If you believe you have a qualifying medical condition that was denied by your LTD insurance company, then it may be time to bring in a fierce advocate to assist you further. A disability attorney has the training, experience, and finesse to maximize your benefits while creating the best possible case.

At Bross & Frankel, P.A., our disability attorneys work tirelessly for residents of New Jersey and Pennsylvania who need LTD benefits immediately. Find your nearby social security disability lawyer:

  • Vineland Disability Lawyers
  • Newark Social Security Disability Lawyer
  • Jersey City Social Security Disability Lawyer
  • Elizabeth Social Security Disability Lawyer

You can schedule a free claim review to learn more about how we can provide you the necessary support for your claim. Request yours today by calling (856) 795-8880 or by sending us a message.

rich-frankel
Rich Frankel

Rich Frankel is the managing partner of Bross & Frankel. He is a member of the New Jersey and Pennsylvania bars. He has focused exclusively on disability and social security benefits since 2005.

Mr. Frankel joined what is now Bross & Frankel after having watched his father struggle with disability, fighting a lengthy illness. Mr. Frankel founded the firm’s veteran’s law practice and substantially grew the social security disability practice, focusing Bross & Frankel’s ability to fight for all of the disability benefits available to his clients.

Mr. Frankel additionally fights for clients in court, obtaining frequent victories in Social Security appeals and against insurance companies in Federal court.

Written by Rich Frankel · Categorized: Long Term Disability

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