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Wondering what medical conditions make you eligible for long-term disability benefits? From chronic pain and serious heart disease to mental health issues like PTSD, knowing which conditions are recognized is key to getting the benefits you deserve. In this article, we’ll cover a range of qualifying conditions and share insights to help you navigate the often complex disability benefits system. With over 25 years of experience representing long-term disability claimants nationwide, we’re here to guide you every step of the way.
Key Takeaways
A wide range of medical conditions can make you eligible for long-term disability benefits. This includes musculoskeletal issues, cardiovascular and neurological disorders, mental health conditions, and chronic illnesses like uncontrolled diabetes and autoimmune diseases.
Understanding your policy’s definitions and keeping detailed, consistent medical records are crucial for a successful long-term disability claim. This highlights the importance of thorough documentation and regular communication with your healthcare providers.
Having a long-term disability lawyer can be essential, especially for complex ERISA claims. Building a strong claim involves maintaining comprehensive medical records, avoiding inconsistencies, and understanding the difference between short-term and long-term disability insurance.
Common Medical Conditions Qualifying for Long-Term Disability
Understanding the complex world of disability insurance, particularly what medical conditions can qualify for long-term disability benefits, can be challenging, even for attorneys.
Conditions that can potentially qualify for long-term disability include:
Alzheimer’s disease and dementia
Chronic pain conditions such as a back injury or carpal tunnel syndrome
Disorders that affect the respiratory system, like chronic obstructive pulmonary disease (COPD) and severe asthma
Disorders that impact the immune system, such as HIV/AIDS, vasculitis, or scleroderma
Hearing and vision impairments, with adequate documentation of the extent of these limitations
The list doesn’t end here. You can visit the BenGlassLaw results page and filter for “long-term disability” to see the many conditions for which we have successfully recovered long-term disability benefits.
Physical Conditions
There are various physical health disorders that can result in long-term disability. Musculoskeletal disorders, like arthritis and chronic back pain, are among the leading causes. These conditions often cause debilitating pain and limit mobility, making everyday tasks difficult.
Cardiovascular diseases, such as heart failure and coronary artery disease, can also qualify for long-term disability benefits. Neurological conditions, including multiple sclerosis, Parkinson’s disease, Alzheimer’s, and stroke complications, are also recognized for long-term disability eligibility.
Chronic illnesses that can qualify individuals for long-term disability benefits include:
Uncontrolled diabetes leading to kidney disease or vision loss
Autoimmune diseases like lupus, rheumatoid arthritis, Crohn’s disease
Disorders like thyroid gland dysfunction
Lastly, individuals suffering from chronic respiratory diseases such as COPD, asthma, or cystic fibrosis, and those who have sustained severe injuries potentially leading to disability claims include spinal cord damage, brain trauma, or significant burns.
Mental Health Disorders
Mental health disorders can also lead to long-term disability. Conditions such as:
Anxiety disorders, including Obsessive Compulsive Disorder and panic disorders, can also qualify for long-term disability, though most often there is a 24-month limitation of benefits for so called “mental and nervous” conditions. Other mental health conditions that can qualify for long-term disability (also with limitations) include schizoaffective disorder, borderline personality disorder, and eating disorders.
In a society where mental health awareness is consistently growing, it’s essential to note that substance use disorders can be recognized by long-term disability insurers as qualifying mental health conditions, though often there are limitations. These disorders can significantly hinder an individual’s ability to function optimally in their work environment, thus qualifying them for long-term disability benefits.
Understanding Policy Definitions of Disability
Understanding the policy definitions of disability is a crucial step in navigating long-term disability benefits. Each policy is unique, and these definitions play a significant role in determining your eligibility for benefits. Typically, long-term disability insurance requires a diagnosis of a disability with restrictions and limitations that prevent you from performing the main duties of your own occupation during the first two years of the claim.
Disability policies may have specific criteria and definitions for qualifying medical conditions, so it’s important to review these definitions and criteria with an experienced long-term disability attorney. For instance, “own-occupation” policies provide benefits if you can’t perform the duties of your specific job due to disability. In contrast, “any-occupation” policies provide benefits only if you can’t perform any job suited to your education, training, and experience.
Another important aspect of disability policies is the “elimination period” or waiting period, which is the time you must wait after becoming disabled before you can receive benefits. Understanding these definitions and terms is vital for successfully navigating your disability insurance claim.
The Role of Medical Records in Disability Claims
Medical records hold a critical role in disability claims. They serve as tangible evidence of your medical condition, its severity, and the treatment you’ve undergone. Therefore, keeping detailed and up-to-date medical records is vital in supporting your disability claim.
Essential documentation includes detailed treatment summaries, specialized tests, and Functional Capacity Evaluations. Psychological testing may also be necessary, especially when mental health disorders are involved. Regular updates to medical records, including ongoing tests and documentation of treatment adherence, are necessary to prove continuous disability and support the receipt of long-term disability benefits.
To ensure that your medical documentation is accurate and comprehensive, here are some steps you can take:
Maintain communication with healthcare providers.
Request copies of medical records.
Be proactive in follow-up and testing.
Include objective medical opinions from peer review physicians to add weight to your claim.
Navigating the Long-Term Disability Claim Process
The long-term disability claim process can often feel like navigating through a maze. From filing the initial claim to appealing denied claims, understanding each step is crucial to reach the finish line successfully.
To start the long-term disability claim process, follow these steps:
Inform your employer about your disability and intent to file for benefits.
File the claim with the necessary documentation, usually with the employer’s disability company or claims administrator
Have your physician evaluate the severity of your condition and its impact on your specific work.
Ask your employer to provide a statement with your job description and work history. This will usually be on a form provided by the disability insurance company or claim adminstrator.
An insurance company may use video surveillance and personal meetings with claimants to gather information that could influence the evaluation of the disability claim. With all these complexities, it’s critical to seek legal assistance when navigating the claim process to avoid pitfalls such as missed deadlines or errant documentation (we offer consultations with our LTD attorneys so you can get advice BEFORE filing you claim), and for help in appealing any denied claims (we offer a free denial letter review where our highly experienced team will review your denial letter and give you personalized feedback for the next steps that you should take – which is not always hiring a lawyer).
How Insurance Companies Evaluate Medical Conditions
Ever wonder how insurance companies evaluate medical conditions for disability claims? They look at the severity of your symptoms and functional limitations, considering your ability to perform work-related activities and your response to symptoms like pain. They also check for any magnification of symptoms.
Insurance companies often require Independent Medical Examinations (IMEs) and evaluations. These tests, conducted by doctors chosen by the insurer, measure your performance abilities and help determine the extent of your disability.
Your treatment history that plays a part in the evaluation of your medical condition for long-term disability claims includes:
detailed medical records
medical opinions
compliance with treatments
vocational assessments
The claim evaluation process incorporates objective medical evidence like diagnostic imaging and lab results, as well as in-house or consultant physician reviews of medical records to validate the limitations claimed by the applicant. Understanding these evaluation processes can help you better prepare for your disability claim.
The Importance of Consistent Medical Treatment
Keeping up with regular medical treatment is crucial for substantiating long-term disability claims. It helps build a detailed history of your disability and its impact on your life. This means keeping records of doctor appointments, medications, and side effects, which together create a comprehensive medical profile for the analyst reviewing your claim.
Insurance companies look at the frequency and consistency of your medical treatment to assess the severity and legitimacy of your claim. Therefore, consistently reporting all symptoms during regular treatment visits is essential. This not only shows how your condition affects your daily life but also helps prevent claim denial or supports an appeal if necessary.
When to Consult a Long-Term Disability Lawyer
The world of long-term disability can be pretty intimidating. That’s where a long-term disability lawyer, like our experienced team comes in. These legal professionals, well-versed in disability law, can assist you at any stage, from filing to appeal. They bring expertise to validate your claims and provide peace of mind throughout the process.
If your claim falls under ERISA, it’s crucial to work with an attorney who understands this complex law. ERISA cases rely heavily on the evidence submitted during the administrative appeal, with strict deadlines and standards. An experienced disability attorney is essential for assembling the claim file for a potential lawsuit, as new evidence is generally not allowed in court after the administrative appeal under ERISA.
The good news? Long-term disability attorneys often work on a contingency fee basis with fees paid only if the claim is successful, typically ranging from 25% to 40% of benefits collected.
Tips for Strengthening Your Long-Term Disability Claim
Having covered qualifying conditions, policy definitions, and the claim process, let’s now shift our focus to ways of bolstering your long-term disability claim. Ensuring that all submitted medical opinions are comprehensive, consistent, and accurate is critical for increasing the chances of a long-term disability claim’s approval.
Maintaining detailed records of doctor appointments, medications, and side effects can create a comprehensive medical profile for the analyst reviewing the disability claim. Some important documents to include in your medical profile are:
Doctor appointment summaries
Medication lists
Test results
Imaging reports
Treatment plans
Therapy notes
Diagnostic testing and additional evaluations, like functional capacity evaluations, offer objective evidence of symptoms and limitations, which is essential for supporting a disability claim.
Avoid common mistakes such as inconsistent symptom reporting and the under-documentation of non-physical symptoms, like mental health issues, as these can significantly undermine a long-term disability claim. Functional capacity evaluations and subjective evidence, provided by self-reported symptoms and testimonies from acquaintances, are beneficial in demonstrating the claimant’s ability or inability to perform work-related physical activities.
Long-Term vs. Short-Term Disability: Key Differences
In the realm of disability insurance, understanding the distinction between long-term and short-term disability insurance is vital. Short-term disability insurance typically has a coverage term between 3-6 months, while long-term disability insurance coverage can range from 5, 10, 20 years, or until retirement age. Navigating through the options provided by a disability insurance company, especially those among billion dollar insurance companies, can be overwhelming, but being informed about the differences is crucial.
The elimination periods for these policies also differ. Short-term disability insurance generally has a couple of weeks, contrasting with long-term disability insurance, which usually has an elimination period around 90 days. The benefit amounts also differ, with short-term disability insurance potentially covering up to 70% of an individual’s income, whereas long-term disability insurance benefits typically range from 40-70% of the pre-disability income.
There are other differences too. Short-term disability insurance may cover pregnancy-related leave, whereas long-term disability insurance usually does not cover normal pregnancy, but may provide coverage for complications. Understanding these key differences can assist you in choosing the right type of disability insurance based on your specific needs.
Social Security Disability Insurance (SSDI) and Long-Term Disability
Lastly, comprehending the correlation between Social Security Disability Insurance (SSDI) and long-term disability benefits is significant. Eligibility for SSDI is contingent on having paid into the system and possessing a qualifying disability. Interestingly, long-term disability benefits policies often necessitate SSDI application, and the approval for SSDI can potentially reduce the total amount received from long-term disability insurance.
Coordination of ltd benefits typically includes:
An offset, with long-term disability payments reduced by the amount received from SSDI
SSDI allows for additional benefits for family members, in contrast to most private long-term disability plans
After 24 months of receiving SSDI, Medicare becomes available as healthcare coverage.
The approval for SSDI benefits can significantly influence the evaluation of long-term disability claims by insurance companies, and securing both types of benefits can lead to a higher cumulative income replacement for the disabled individual. Understanding how SSDI and long-term disability benefits interact can help you optimize both benefits.
Summary
We’ve explored the landscape of long-term disability benefits, covering qualifying conditions, policy definitions, the importance of medical records, and the claims process. We’ve also highlighted the value of consistent medical treatment and legal assistance, along with tips for strengthening your disability claim.
As you navigate your journey through disability claims, remember that knowledge is power. Understanding your rights, the details of your policy, and the nuances of the claims process can empower you to manage your claim effectively and secure the benefits you deserve.
BenGlassLaw fights for wrongfully denied long-term disability claimants across the nation.
Since 1995, BenGlassLaw has been helping sick, injured, and disabled workers fight unfair claim denials, get the benefits they paid for, and get their lives back on track. We are passionate about restoring our client’s denied benefits because insurance policies should be part of the solution, not a cause of additional stress. What makes our team unique?
Our Experience. We file more long-term disability appeals and lawsuits than any other firm in the Mid-Atlantic. (Source: Pacer, the official government site for Federal Court lawsuits)
Our Leadership. Our work in ERISA Law is recognized and respected across the nation. We speak at national events and teach other national disability attorneys about our own techniques and processes for handling ERISA and life insurance denials.
Ongoing Support. Once we get our clients back on claim, it’s never them vs the insurance company again. For as long as our client receive benefits, we handle the insurance company — which is why we manage over $33 million in future disability benefits on behalf of our clients.
Listen to Ben Glass Argue Long-Term Disability Cases in Court. Want to hear Ben work before you hire the BenGlassLaw Long-Term Disability Team? You can listen to Ben Glass at work in long-term disability cases here.
