We buy insurance to protect us in case something bad happens: car insurance covers property damage and other losses in the event of an accident, health insurance covers medical treatment, and homeowners insurance pays for losses from fires and other disasters. In the same way, long-term disability insurance provides a financial safety net if you are unable to work due to a disability.
There are a number of long-term disability requirements that you must meet in order to be eligible for benefits. Generally, the two main requirements are (1) having a covered disability, per the terms of your policy; and (2) being unable to work due to that disability. If you can prove these two things, then you will likely qualify for long-term disability benefits.
The process of applying for benefits can be challenging, particularly because eligibility often hinges on a technical reading of length insurance policy documents. A New Jersey disability benefits attorney can help you apply, including gathering the necessary evidence to support your claim.
Requirements for Long-Term Disability Benefits
Long-term disability (LTD) insurance is a specialized type of insurance policy that is designed to cover your income when you are unable to work for an extended period of time. Depending on the terms of your policy, these benefits may last for 2 years, until your disability resolves, or even to retirement age. While each LTD policy is different, they typically provide benefits of up to 50 to 60% of your monthly salary for covered disabilities.
Many people have LTD policies through their work, while others purchase a policy on their own. If your LTD policy was obtained through a group plan, then it will be governed by the federal Employee Retirement Income Security Act of 1974 (ERISA), which sets forth specific rules for this type of policy. If you purchased your own LTD policy, then any disputes under the policy will be handled under state law.
LTD policies define disability in two ways: “any” occupation or “own” occupation. “Any” occupation policies pay benefits if you are unable to work in any job for which you are qualified. In contrast, “own” occupation policies will pay benefits if you cannot work in your specific job. Most “own” occupation policies convert to “any” occupation policies after a set period of time.
To qualify for LTD benefits, you must meet the following basic requirements:
- Have an LTD policy, either through a group plan or purchased individually;
- Have a covered disability based on the terms of your policy;
- Be disabled for an extended period of time;
- Have sufficient medical evidence and records to support your diagnosis; and
- Wait until the expiration of the elimination period (typically, 3 to 6 months) to apply.
Because every insurance policy is different, the qualifications for LTD benefits may vary significantly for each person.
Eligibility Conditions for LTD Benefits
There is a wide range of medical conditions that may qualify you for LTD benefits. The critical factor is that the health issue is severe enough that you are unable to work, either in your own job or in any occupation (depending on the policy). You will need to submit medical records and other evidence that demonstrates that your condition renders you unable to work, either on its own or through a combination of this condition, another health issue, and/or the side effects of medication used to treat it.
Medical conditions that may lead to disability include:
- Cervical stenosis
- Chiari malformation
- Muscular dystrophy
- Rheumatoid arthritis
- Alzheimer’s disease
- Amyotrophic lateral sclerosis (ALS)
- Multiple sclerosis (MS)
- Traumatic brain injury (TBI)
- Meniere’s disease
- Chronic obstructive pulmonary disease (COPD)
- Coronary heart disease
- Heart failure
- Crohn’s disease
- Irritable bowel syndrome (IBS)
- Sickle cell disease
- Multiple myeloma
- Acute leukemia
Mental health conditions may also qualify for LTD benefits. However, many policies place a 24 month limit on benefits for psychiatric or substance abuse disorders. There are some exceptions to this type of policy, such as for situations where a person is receiving inpatient care at the time that their benefits expire.
A range of mental health diagnoses may qualify you for LTD benefits, including:
- Anxiety disorder
- Bipolar disorder
- Drug addiction
- Obsessive-compulsive disorder (OCD)
- Panic attacks
- Post-traumatic stress disorder (PTSD)
Because limitations and exclusions for mental health disorders and related conditions can be complicated, be sure to check with an experienced LTD benefits attorney before starting the application process.
How to Get Approved for LTD Benefits
Getting approved for long-term disability benefits is a multi-step process. To be eligible, you must demonstrate that (1) you have been diagnosed with a covered medical or mental health condition; and (2) your diagnosis makes you unable to work. The most crucial aspect of getting LTD benefits is showing that your health issue makes you unable to work.
For example, if you have been diagnosed with carpal tunnel syndrome (CTS), you may be able to return to work after a few weeks of treatment. In other situations, you can’t return to work for an extended period of time because the condition was caused by performing repetitive motions at work. In this situation, you will need to show that:
- Your CTS disability is ongoing; and
- You cannot work due to your CTS.
This can be demonstrated through medical records related to your CTS diagnosis, such as the results of a nerve conduction study and an electromyogram. Your treating physician should also submit a letter that details your limitations due to your CTS. A skilled New Jersey LTD benefits lawyer can then put together a comparison of these limitations and your job duties to illustrate your inability to work.
Insurance companies may use a variety of tactics to deny or minimize legitimate LTD claims. This may include an overly broad reading of limitations and exclusions, terminating benefits before a disability has resolved, or even using surveillance to gather evidence that an applicant isn’t truly disabled. If the insurer acts in bad faith or violates ERISA rules in denying your application, your attorney may be able to appeal that decision, or even file a lawsuit against them in federal or state court.
Filing for Long-Term Disability Benefits? We Can Help.
You have long-term disability insurance for a reason: to protect yourself in the event that you can’t work due to a disability. While being approved for LTD benefits should be relatively straightforward, the process is often complex, requiring you to jump through bureaucratic hoops to get the benefits that you are entitled to under the terms of your policy.
At Bross & Frankel, we are dedicated to helping people with disabilities get the benefits that they both need and deserve — including LTD benefits. We treat each of our clients with compassion, all the while putting together a strong claim for benefits. To learn more or to schedule a free claim review with a New Jersey LTD benefits lawyer, call us at 856-795-8880 or email us at any time.
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.