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What Medical Conditions Qualify for Long Term Disability?

What Medical Conditions Qualify for Long Term Disability

Are you wondering what medical conditions qualify for long term disability benefits? Many medical conditions qualify someone for disability if severe enough. Examples include back and neck problems, multiple sclerosis, epilepsy, non-epileptic seizures, cancer, and Parkinson’s disease. However, we often find that a claimant’s disability is not due to a single illness or injury. Instead, we usually find that a person’s combination of impairments renders him or her disabled.

Illnesses and injuries are compounded by other illnesses and injuries. Moreover, a claimant’s medical problems may be further compounded by chronic pain or fatigue and by negative side effects to potent medications. So, with that in mind, what medical conditions qualify for long-term disability? Almost any combination of medical conditions, if severe enough, will prevent you from working.

What If The Combined Effects of Multiple Conditions are Disabling?

Disability insurance companies tend to evaluate whether conditions qualify without appreciating the full impact that the illness and/or injury has on your life. For example, do your medical records adequately convey the fact that you are constantly in pain? Does sleep deprivation leave you extremely fatigued during the day? Has your doctor stated that you are unable to work? You need to make sure all of your symptoms and limitations are documented during the claims process so the insurance company will approve your claim for short-term disability or long-term disability benefits.

Each illness and injury has a range of symptoms, including pain, fatigue, cognitive mental deficits, and negative side effects to medication. Here at the Ortiz Law Firm, we recognize that your disabling illnesses and/or injuries are best presented in combination. It is not simply a matter of determining the appropriate diagnoses for your medical problems. It is also important to understand how your illnesses and injuries affect your ability to perform daily activities and impair your ability to perform full-time work activities.

The Ortiz Law Firm makes connections between your documented medical conditions and your resulting impairments. This enables us to properly develop your disability case as your advocates. Long-term disability attorney Nick Ortiz uses his experience in handling a wide variety of medical problems to work with your doctors to obtain medical opinions that will be important to getting your benefits approved on appeal or in litigation. The Ortiz Law Firm is ready to support you in getting your long-term disability claim approved or reinstated so that you receive the disability benefits you are entitled to under your insurance policy.

Medical Conditions That May Qualify for Long Term Disability

So what medical conditions qualify for long-term disability? Below is a list of qualifying conditions that may be considered severe enough by disability insurance companies to qualify a claimant for short-term disability, long-term disability, or individual disability insurance benefits. These conditions and/or the necessary medical treatment can significantly interfere with an individual’s ability to obtain and maintain gainful employment, thereby making such individuals eligible for disability insurance benefits.

Long Term Disability for Musculoskeletal Disorders

Long Term Disability for Neurological Disorders

Long Term Disability for Autoimmune Disorders

Long Term Disability for Mental Disorders

Long Term Disability for Special Senses and Speech Disorders

Long Term Disability for Respiratory Disorders

Long Term Disability for Cardiovascular and Circulatory Disorders

Long Term Disability for Digestive Disorders

Long Term Disability for Infections and Parasitic Diseases

Long Term Disability for Genitourinary Impairments

Long Term Disability for Hematological Disorders

  • Aplastic Anemia with Bone Marrow or Stem Cell Transplantation
  • Chronic Anemia
  • Chronic Granulocytopenia
  • Sickle Cell Disease
  • Chronic Thrombocytopenia
  • Coagulation Defects and Hemophelia
  • Hereditary Telangiectasia
  • Hemochromatosis
  • Liver Transplantation
  • Polycythemia Vera
  • Spleen Diseases
  • Systemic Vasculitis

Long Term Disability for Skin Disorders

Long Term Disability for Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders

Long Term Disability for 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

Long Term Disability for Cancer and Malignant Neoplastic Diseases

Long Term Disability Due to Symptoms, Signs and Subjective Conditions

This list is not exhaustive, and you may still qualify for long-term disability benefits even if your condition is not listed above. Each case is unique, so we encourage you to contact us for help determining whether will be able to access long-term disability benefits. We will help you determine if you qualify to receive benefits under the terms of your insurance policy.

Why Would Long-Term Disability be Denied?

Long-term disability claims can be denied for various reasons. Some of the most common reasons for denial include:

I Was Approved for Social Security Disability, but My Long Term Disability Claim Was Terminated

Qualifying for short-term or long-term disability benefits is very different from qualifying for Social Security Disability benefits. We frequently receive calls from claimants whose long-term disability claims were terminated, but they continue to receive Social Security Disability benefits. For example, The Social Security Blue Book is the Social Security Administration’s (SSA) listing of disabling impairments. The Blue Book lists specific criteria under which claimants who suffer from a disabling condition can qualify for Social Security disability benefits. Your long-term disability insurance company will not use the same criteria to evaluate your claim.

What If I Can Only Work Part-Time?

If your medical conditions prevent you from working full time, but you can still work part-time, you’ll need to check your insurance policy to make sure benefits are payable for partial disability. The exact definition of partial disability will vary between policies. Some policies may not pay any benefits for partial disability. If you’re not sure if your policy includes benefits for partial disability, request a free case evaluation.

Objective Evidence to Support a Long Term Disability Claim

The burden to prove that a condition has impacted the claimant in such a way that they are unable to work falls on the claimant. You are expected to provide medical evidence to support your claim during the claims process. It is not unusual for an insurance company to require proof of objective evidence before it will pay long-term disability benefits. Objective evidence is the evidence in your medical records that insurance companies cannot deny exists. It may be difficult to qualify for benefits if there is no objective evidence to support your claim.

Why Objective Evidence is Needed

Objective medical evidence includes medical signs and laboratory findings. Signs are anatomical, physiological, or psychological abnormalities that can be observed by a medical provider. Signs are separate from the claimant’s statements (which are often referred to as “subjective complaints” or symptoms). Signs may be shown by medically acceptable clinical diagnostic techniques.

Psychiatric signs are medically demonstrable phenomena that indicate specific psychological abnormalities, e.g., abnormalities of behavior, mood, thought, memory, orientation, development, or perception. They must also be shown by observable facts that can be medically described and evaluated. Laboratory findings are anatomical, physiological, or psychological phenomena that can be shown by the use of medically acceptable laboratory diagnostic techniques. Some of these diagnostic techniques include chemical tests, electrophysiological studies (electrocardiogram, electroencephalogram, etc.), X-rays, MRIs, CT-Scans, blood tests, and psychological tests.

Objective evidence is especially important in proving hidden disabilities that are typically diagnosed based on the claimant’s subjective complaints, such as fibromyalgia, chronic pain syndromes, chronic fatigue syndromes, and chronic back pain conditions.

Objective Testing

Psychological and neuropsychological testing are objective tools that may be used to defeat the insurance company’s position that the claimant is malingering or exaggerating his or her disabling condition.

A functional capacity evaluation (FCE) may also provide objective clinical evidence to prove whether the claimant is physically capable of performing the regular duties of a specific occupation.

What If Objective Evidence is Not Available?

When conclusive objective evidence is unavailable, a disability may still be validated through the use of subjective evidence. Subjective evidence is a combination of the patient’s self-reports and the observations of friends and family. If objective evidence is unavailable to prove up a claim, we will develop subjective evidence to ensure that we “stack the record” with all available information substantiating disability. It is possible to qualify for benefits even if objective evidence is unavailable.

Is Coverage Limited for Certain Conditions?

Mental Health Conditions

Most LTD policies have a maximum payout of 24 months for mental health conditions. These conditions could include medical conditions like depression (including postpartum), bipolar disorder, PTSD, and anxiety. The insurance company uses the reasoning that these illnesses are hard to prove with medical testing and lab reports, so they can be faked or exaggerated. Although these illnesses are serious, you must prove the existence of your illness and the resulting limitations. That is very hard to do.

Chronic Medical Conditions

Some LTD policies have a maximum payout for chronic illnesses like arthritis, back pain, and carpal tunnel syndrome. Conditions associated with lifestyle choices like COPD from tobacco use, alcoholism, or other diseases related to drugs or alcohol use could result in termination of benefits after 24 months or less. Check your policy for limitations based on these types of conditions.

Request a Free Case Evaluation

The most difficult part of the long-term disability claim process is obtaining the evidence to support your claim. The burden of proof falls on the claimant, and you will need to submit proof of your disability to the adjuster that is assigned to your claim. You need to include objective evidence from each doctor treating you, not just your primary care doctor. If objective evidence is not available, you need to include self-reports and statements from friends and family.

You do not have to carry the burden alone. If your medical condition makes it impossible for you to work and you have been denied your disability benefits, long term disability attorney Nick Ortiz and the legal team at Ortiz Law Firm can help you cut through the red tape and fight for the disability benefits you deserve, no matter where you live in the United States or what medical condition you have. We have represented claimants in claims with Cigna, Hartford, Lincoln, MetLife, Prudential, Reliance Standard, Unum, and a variety of other disability insurance companies. Call us today at (888) 321-8131 to discuss your claim.

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