How is Long Term Disability Determined?


Few things are more frustrating than being unable to engage in normal activity due to personal injury or illness. Generally, we hope to recover from these maladies as soon as possible and move on, but this isn’t always an option. Whether it’s a back injury or chronic illness, some conditions require long term treatment.

They also require long term benefits to cover them. These are normally supplied through an employer’s benefits program or a separately purchased insurance policy. But an important thing to realize is that different employers and different insurance companies can have varying definitions of what constitutes a long term disability. If you think you qualify for coverage, you still need to know how these things are typically determined.

Defining long term disability

A long term disability is typically defined as either a personal injury or illness that prevents you from performing at work. If this is from an injury sustained at work, then you would be covered by your employer’s workers’ compensation benefits, starting with the short term benefits. These benefits usually cover a period of one to three months before the long term benefits begin. Long term benefits are frequently good for three to five years, although some plans will pay a portion of an employee’s salary up to age 65.

If you don’t get benefits through an employer, then it’s possible to purchase an individual plan from an insurance agency. Just remember that with either approach, insurance companies make their money by not actually giving out benefits. To that end, plans usually contain vague language and complex terms to help them deny claims or only provide a portion of the benefits. That said, there are steps you can take to get the benefits you deserve.

Denial is not the end

Just because a claim gets denied at first is no reason to give up. Bringing in a long term disability lawyer is always an option, and many of them operate on contingency fees, so you’ll only owe them if they win your case. Still, there’s nothing stopping you from trying to make a disability claim on your own. You’ll need to evaluate your situation and create a convincing argument for why you need long term disability benefits. Make sure to get your doctor’s support beforehand, as it’s necessary for any claim. As long as you can convince your doctor you’ve done everything to try and stay employed, they’ll have no reason to deny support. At that point, it’s just a matter of filling out the application and other paperwork and waiting for a response.

An initial denial shouldn’t scare you away, and it won’t scare a willing attorney away either. In fact, there are some attorneys who won’t bother to accept a case until a claim has already been denied. At this stage, an attorney can assist you through the appeals process. This will begin with a request for reconsideration, but this is not likely to be enough on its own. You most likely will have to attend a hearing, and you’ll have a much higher chance of success with legal representation. Attempting to represent yourself in this matter will almost surely fail. And if that happens, you would have to start the entire application process over again, which is time you simply can’t afford.

If by some chance, an attorney refuses to take your disability case, make sure to have them explain why. It could be a variety of reasons like perceived lack of medical evidence, history of substance abuse, or even an applicant’s age. You’ll likely always have to fight on some level for your disability benefits, so use any information you can obtain to build a stronger case for the next attempt.