Lower Extremity Fractures and Long-Term Disability Insurance Claims

A fracture of the femur, tibia, fibula, or pelvis can dramatically affect your mobility and ability to work—especially in physically demanding jobs. While some fractures heal within a few months, others may require extended recovery time or result in permanent impairments. If you’re unable to return to work due to a serious lower extremity fracture, you may qualify for long-term disability (LTD) benefits.

This article explains how fractures of major lower-body bones can lead to disability, what documentation you need to support your LTD claim, and how a disability attorney can help if your claim is denied.

Can a Femur, Tibia, Fibula, or Pelvis Fracture Qualify for Long-Term Disability Benefits?

• Extended immobilization
• Multiple surgeries
• Assistive devices such as walkers or canes
• Ongoing physical therapy
• Long-term pain management
• Modified weight-bearing or lifting restrictions

These limitations may prevent you from standing, walking, climbing, lifting, or balancing, which are essential in many types of work.

Applying for Long-Term Disability Benefits After a Lower Extremity Fracture

Before applying for LTD benefits, review your disability insurance policy carefully. If you have a group policy through your employer, request a copy from your human resources department.

Each policy defines “disability” differently, but most follow a two-tier definition:

• Own Occupation Period (typically the first 24 months): You are disabled if you cannot perform the material duties of your specific job.
• Any Occupation Period (after 24 months): You are disabled if you cannot perform the duties of any occupation for which you are reasonably qualified by education, training, or experience.

RELATED POST: How To Apply For Long-Term Disability Insurance Benefits

Strengthening Your Long-Term Disability Claim

To improve your chances of approval, build a strong administrative record by including the following:

Medical Evidence

• X-rays, CT scans, or MRIs showing the fracture
• Surgery and hospital records
• Ongoing progress notes from your orthopedic specialist
• Physical therapy records and limitations documented in rehab
• Pain management documentation, including medication history

Functional Limitations

Explain how your injury prevents you from performing your job duties. Common examples include:

• Inability to stand or walk for extended periods
• Difficulty with climbing stairs or ladders
• Balance issues or fall risk
• Need for leg elevation to manage swelling
• Restrictions on lifting, bending, or stooping

Ask your doctor to complete a Residual Functional Capacity (RFC) form, which outlines your physical limitations in detail.

Physician Support Letter

A letter from your treating physician should clearly state:

• Your diagnosis and treatment history
• Prognosis and expected recovery timeline
• Functional limitations relevant to your job duties
• Whether returning to work would pose a risk of reinjury

RELATED POST: Why Your Doctor Must Document Your Functional Limitations

What Is the Administrative Record?

The administrative record is everything the insurance company will consider during your claim and any potential appeal. It includes:

• All claim forms and correspondence
• Your medical records
• Functional assessments and physician opinions
• Any surveillance footage gathered by the insurer
• Reports from third-party evaluators (e.g., independent medical exams)

The strength of your administrative file plays a crucial role in whether your claim is approved or denied. That’s why it’s so important to submit complete, accurate, and timely information from the very beginning.

What If You’re Denied Long-Term Disability Benefits?

Denials are common—even for serious injuries. However, a denial does not mean your claim is over. You have the right to file an appeal, and this is often your last chance to submit new medical evidence.

An experienced disability attorney can:

• Review your denial letter and policy language
• Help gather updated medical records and RFC forms
• Communicate with your doctors to prepare stronger documentation
• Draft and file a persuasive appeal letter
• Represent you during interviews or examinations
• Guide you through litigation if necessary

Get Help with Your Long-Term Disability Claim

Filing for long-term disability after a fracture may seem straightforward, but it often isn’t. Insurance companies frequently minimize the impact of orthopedic injuries, especially if you’re expected to “recover” eventually. But if complications persist, or if your job requires physical activity you can no longer perform, you may still qualify for benefits.

We help appeal long-term disability insurance denials. Working with an experienced disability attorney gives you the best chance of approval. At the Ortiz Law Firm, we represent claimants nationwide and there are no upfront costs. We only get paid if we win your case.

Contact Us for a Free Case Evaluation

If you’ve suffered a lower extremity fracture that has made it impossible to return to work, let us help you fight for the benefits you deserve.

Call the Ortiz Law Firm at (888) 321-8131 for a free case evaluation. We’ll review your case, explain your options, and guide you through the next steps.