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Are you or a loved one wondering how to apply for long-term disability? Understanding the process thoroughly is crucial to ensure you have the best chance of receiving the support you deserve. This post explains the application process and offers expert tips to help you navigate it confidently.
This guide is written by a disability attorney for non-attorneys who must go out on disability. You can think of this guide as a cookbook written by a professional chef. Simply reading the cookbook does not guarantee you will be as good a cook as the author, but your chances of success are much higher than someone trying to recreate one of the chef’s dishes without any guidance.
DISCLAIMER: This book gives advice concerning the disability insurance claim process, and I am providing tips and suggestions, but the information contained in this book is not legal advice and should not be taken as such. Each claim is as unique as the claimant making the claim. The tips and suggestions in this guide may not be appropriate for your case.
We also encourage you to download a PDF copy of the Disability Insurance Claim Guide and Toolkit. It contains several worksheets to help you organize all the necessary information to support your claim. We reference these worksheets throughout this guide.
Your Guide to Filing a Long-Term Disability Claim
Step 1: Determine The Benefits You Are Eligible For
The first step in the long-term disability claim process is identifying the benefits you can receive. Some individuals may be eligible to receive disability insurance benefits from more than one source. You must determine all available benefits so you can plan your financial future.
Step 2: Gather Evidence to Support Your Claim
The second step in the process is to document your disabling medical condition(s) with medical and vocational evidence. Your claim is only as strong as the evidence you submit. It would be best not to rely on your insurer to request your records, as it is not obligated to do so.
Step 3: Tell Your Story
The third step in the process is to bridge the gap between your diagnosis and your resulting impairment. This means you need to explain to the insurance carrier how your symptoms and limitations prevent you from performing the duties of your occupation. Claimants must explain their job duties and why they cannot continue performing them.
Step 1: Determine The Benefits You Are Eligible For
The first step in the long-term disability claim process is identifying the benefits you can receive. Use the “Available Benefits Worksheet” to keep track of the waiting period to receive benefits, how long benefits can be paid, and how much you should receive each month.
Employer Benefits
Many employers offer long-term disability (“LTD”) coverage as part of a group employee benefits plan. You can identify employer benefits by reviewing your employee handbook or any summary plan descriptions (“SPDs”) you may have received. The SPD will also include the following information:
Waiting Period
The waiting period (or elimination period) for long-term disability benefits is usually 90 to 180 days. This means that benefits are not payable until you have been continuously out of work for that number of days due to your disabling condition.
Nick’s Tips:
You can obtain a copy of your employee handbook or the SPD through your human resources department. To protect your privacy and avoid attracting unwanted attention, request copies of all your employee benefit plans.
Maximum Benefit Period
Most LTD policies will only pay benefits for a certain amount of time. The maximum benefit period is usually to age 65 or your Social Security Normal Retirement Age (“SSNRA”). Many policies have a shorter reduced maximum benefit period if you are disabled due to a mental illness – typically only 24 months.
Gross Benefit Amount
Most policies’ gross monthly benefit amount is 60% of your pre-disability wages. Whether this calculation includes your bonuses depends on the terms of your specific policy. However, LTD policies almost always allow the insurer to reduce your benefits by the amount you receive in Social Security Disability or Workers Compensation benefits.
Individual Benefits
If you purchased coverage independently, you have an individual disability insurance policy. Your policy contains all the details about your coverage, including your waiting period, maximum benefit period, and benefit amount.
The waiting period is typically 60 to 180 days. Benefits are typically paid until you reach age 65 or for life, so long as you are disabled. The monthly benefit amount may be fixed instead of a percentage of your income. You may also be eligible for a cost of living adjustment called a COLA adjustment.
Nick’s Tips:
If you have an individual disability insurance policy, you can request a copy from your insurance broker or the insurance company. It is best to submit your request in writing and make sure you also request any policy amendments or riders.
Step 2: Gather Supporting Evidence
The insurance adjuster is looking for any reason to deny your claim. Several critical pieces of evidence will help you strengthen your claim. Collect all the supportive evidence you intend to submit with your application. Evidence should include:
Medical Evidence
Your medical evidence should include all physician treatment notes, radiology and surgical reports, and emergency room and medication records. Sort these by the doctor and sort each doctor’s notes by treatment date. Separate MRI/CT scans (reports only, no films) or other lab reports.
Attending Physician Statements
You will need your doctor to complete an attending physician statement (“APS”) or residual functional capacity (“RFC”) form. The doctor doesn’t need to state that they think you’re “disabled.” It is more important for the doctor to identify your level of impairment.
Vocational Evidence
Vocational evidence can also help support your claim. Submit a copy of your job description, any performance evaluations documenting a decline in your performance, statements from coworkers or supervisors, and anything else supporting your claim.
Staying Organized
In the PDF version of this guide, we have included three worksheets to assist you in documenting your disability by organizing information about your medical providers, medications, and treatment history.
RELATED VIDEO: What Kind of Evidence Is Used To Evaluate My Long-Term Disability Claim?
Step 3: Tell Your Story
During the application process, the insurance company typically sends you a written questionnaire or asks you to perform a phone or field interview. They’ll ask you to identify some of your problems because of your condition, but that structure doesn’t give you much opportunity to tell your whole story.
What Do You Mean By “Your Story”?
You must explain your limitations so the insurance company can understand why you cannot work. You do that by showing how your symptoms affect your ability to perform your job duties.
For example, let’s say I have a client who has multiple herniated discs, and it impacts their abilities. They can’t lift and carry more than five pounds across the room. Due to extreme pain, they must lie down several times a day, for several hours each time, to relieve the pressure and pain in their back. That is hugely different from saying, “I’d be working if I could.”
Answer the questions below to help tell your story.
How Did You Become Disabled?
You must explain why you could work one day but not the next. If your disability is due to a specific injury or event, such as a car accident or a heart attack, then identify it. If your condition progressed over time, explain how your symptoms worsened.
Has Your Treatment Been Helpful?
You must show your insurer that you are receiving treatment and doing everything possible to recover. Describe the treatment you have received and how effective it has been. Treatment may include office visits, urgent care visits, hospital stays, emergency room visits, surgical notes, therapy, medications, and assistive devices. If you have experienced adverse medication side effects, document that as well.
What Are Your Job Duties?
Do not assume that your insurer is familiar with the duties and requirements of your job. Your insurer may focus on the physical requirements but do not forget the non-physical aspects of your occupation.
How Does Your Condition Prevent You from Performing Those Duties?
Finally, it would be best if you made a connection between your diagnosis and your inability to work. Explain how specific limitations and symptoms prevent you from performing specific job duties. For example, if you have a desk job and severe back pain, one possible limitation is that you cannot sit at a desk all day.
Nick’s Tips:
Most policies cover your occupation, not your job. This means the insurer is not interested in issues specific to your company. For example, let’s say a claimant suffers from a toxic work environment due to a demanding boss. Focusing on this employer-specific issue will only hurt the claimant’s chance of approval.
In the PDF version of this guide, we have included three worksheets to help you describe your job duties, your symptoms, and how those symptoms prevent you from performing your job duties.
Moving Forward
Applying for long-term disability benefits involves more than filling out a few forms; it is a complex procedure that requires meticulous planning, exhaustive documentation, and strategic action. Each step, from the moment you review your plan document to the day you submit your application, is a building block in your case.
This long-term disability claim guide will help you tell your story in such a way that the insurance company understands why you cannot continue working. Take the time to review the material and complete the PDF worksheets, and you will be better prepared to tell your story and defend your claim for long-term disability benefits.
Missing any of these steps or failing to give them the attention they deserve could result in delays or denials. In contrast, diligent attention to each step enhances your chances of securing the benefits needed to maintain your quality of life.
By following these steps, you are arming yourself with the knowledge and tools to navigate this complex process. With careful planning and the proper support, securing your long-term disability benefits becomes significantly less daunting.
What If My Long-Term Disability Claim Is Denied?
Applications for long-term disability insurance are usually denied because the claimant did not provide sufficient evidence – particularly medical records – for approval. This is why it is so important to double-check everything before you submit it.
- Did you provide the correct doctor’s names and addresses?
- Did you identify all other medical providers, such as physical therapists, mental health counselors, clinics, and hospitals?
- Did you provide the correct dates of service?
- Was all of your medical treatment documented?
- Were all of your resulting impairments noted?
- Was there enough good evidence to support the claim?
Most claims are denied due to simple mistakes that can lead to months of frustration. Some insurance companies will try to point out “bad facts” in your medical record. Bad facts may include:
- Evidence of drug abuse or alcohol abuse.
- Notations of work activity after you said your disability started.
- A doctor notating that you are exaggerating your claim.
- Inconsistent evidence in your file that you appear to be doing more than you claimed on your LTD application.
Get Help with Your Long-Term Disability Claim
As experts in long-term disability insurance, we understand the complexities and challenges that individuals may face when dealing with an insurance company. We believe everyone deserves access to the benefits they are entitled to, so we are here to help you navigate the complex road to receiving disability insurance benefits.
The Ortiz Law Firm is a national disability law firm based in Pensacola, Florida, but we represent clients nationwide. We specialize in long-term disability appeals and litigation. The firm is dedicated to helping people recover the disability benefits they deserve, and we have recovered millions of dollars in benefits for our clients.
If your LTD claim has been wrongfully denied or terminated, and you’d like to speak to an experienced long-term disability attorney, contact us online or call (888) 321-8131 to schedule a free case evaluation with long-term disability attorney Nick Ortiz.
