Long-term disability insurance is a lifeline for those who become unable to work because of a serious injury or a medical condition. As many as one in four adults in the U.S. has some type of disability, according to the CDC, and in some cases, these conditions make earning a living impossible.
Unfortunately, not everyone has long-term disability insurance, and those who don’t have few options beyond trying to qualify for government benefits through Social Security. However, if you do have a long-term disability policy purchased on your own or were offered long-term disability insurance through work, your policy may provide the financial stability you need if you become one of the millions who are disabled.
You need to determine if your policy will cover your condition, though. The best way to do that is to work with an Atlanta, GA, long-term disability attorney who can provide personalized advice based on the specifics of your insurance coverage. Julie A. Rice Law can help with reviewing your insurance details, as well as with submitting an application that maximizes your chances of approval after you develop a serious condition that affects your work abilities.
If you are still in the preliminary stages of researching, though, it can be helpful to review a list of conditions that typically qualify you for long-term disability coverage. Your own policy may differ slightly in what it covers, but this guide will explain some of the medical issues that may qualify you for benefits under most long-term disability policies.
Conditions that qualify you for long-term disability benefits
Some of the different kinds of medical issues that can often allow you to qualify for a long-term disability policy include:
- AIDS
- Arthritis
- Bipolar disorder
- Blindness
- Cancer
- Cardiovascular diseases, including congestive heart failure
- Cerebral palsy
- Chronic Fatigue Syndrome
- Degenerative disc disease
- Depression
- Epilepsy
- Fibromyalgia
- Herniated discs
- Huntington’s Disease
- Lyme disease
- Migraines
- Multiple sclerosis
- Parkinson’s disease
- Spinal disorders
- Stroke
This is not an exhaustive list of conditions, and not everyone with these conditions will qualify for benefits under every long-term disability policy.
For example, while severe arthritis may entitle you to benefits, milder arthritis may not. Likewise, while some cancers require extensive and debilitating treatment, others have a very high cure rate with minimal treatment, so cancer could sometimes be a covered condition under a long-term disability policy — but in other situations, it may be a short-term condition that is only covered by short-term disability or even by regular sick leave.
Your long-term disability policy should have a very clear definition of conditions that qualify. You’ll need to look at the specifics to see if your medical issues are covered.
Own occupation vs. any occupation policies
Generally, a long-term disability policy should cover you if you have a serious, documented medical issue that makes it impossible for you to perform work for an extended period of time. However, the key question is, what kind of work does your condition need to affect?
For example, if you have carpal tunnel, you may be unable to do work in a factory where your job requires repetitive motion — but you may be able to do a customer service job that doesn’t require you to use your body much.
That’s why you need to look carefully at your coverage to determine if your policy uses the “own occupation” standard of disability or the “any occupation” standard. Your coverage may differ dramatically depending on your policy type. For example;
- An own occupation definition means that if you cannot do your job, or one substantially similar to it, you should be entitled to benefits.
- An any occupation definition means that you are entitled to benefits only if you cannot do any occupation that you may be qualified for based on your skills, ability, employment history, and health status
Many long-term disability policies use the own occupation definition, which results in coverage in more circumstances, but you need to know the specifics of your own policy to understand how broad your coverage is and if your condition is likely to qualify you for benefits.
Proving you have a disabling condition
When you claim that you have a covered condition that entitles you to long-term disability benefits, your insurer is generally going to want proof that:
- You have the condition
- Your symptoms rise to a certain level of severity
- Your condition affects your ability to work over the long term
- You are following your doctor’s recommended treatment plan to try to recover from the condition
Insurers don’t want to agree to pay your claim, so it is going to be up to you to have documented medical records demonstrating that your condition is impairing enough that your policy should cover you.
For example, if you have an autoimmune disorder such as rheumatoid arthritis (RA), you’d need to show the extent of your joint deformities, chronic pain, and functional limitations so your insurer could determine if you should receive benefits.
With some medical conditions, you may also be asked to provide evidence on an ongoing basis that you meet the definition of disabled, so you won’t be done after the initial application process. For example, if you suffer from a stroke that causes impairments but you undergo rehabilitation and are able to recover some of your range of motion, you may need to prove to the insurer that you are still disabled enough to deserve benefits over time.
An experienced long-term disability lawyer at Julie A. Rice Law can help you gather the necessary proof to make your claim, so you can maximize your chances of loan approval.
Getting help from a long-term disability lawyer in determining if your condition qualifies
Julie A. Rice Law helps clients determine if they qualify for long-term disability and provides help in putting together a strong application to prove it.
Our legal team has decades of collective experience helping clients to both submit successful initial applications and to fight denied claims and put together a successful appeal.
If you have a medical condition that you believe should entitle you to benefits, give us a call today to talk with an Atlanta long-term disability attorney for help.