Long-Term Disability: Steps to Take If Your Claim Gets Denied

Long-term disability is a topic that affects many individuals worldwide, and it is crucial to gain an understanding of its implications, coverage options, and the importance of being prepared for such circumstances. Long-term disabilities can take various forms, such as chronic illnesses, injuries, or conditions that limit a person's ability to work and maintain their regular lifestyle over extended periods.

It is essential to address this topic because, despite the unpredictability of encountering a long-term disability, its effects can be physically and financially straining for individual and their families. In this article, we will discuss the significance of having long-term disability insurance, the factors to consider when selecting the coverage most suitable for your needs, and steps to increase your chances of obtaining adequate support should you ever need to rely on it.

Definition and Types of Long Term Disability

Long-term disability (LTD) refers to a condition that prevents an individual from performing their regular work duties for an extended period. LTD is often caused by illness, injury, or accidents that render an individual unable to earn a living.

There are two main types of long term disability insurance policies, group and individual:

● Group policies: Typically provided by employers, these policies offer employee coverage as part of their benefits package. The coverage usually includes a percentage of the individual's salary, typically 40-60%, up to a specific maximum limit per month.
● Individual policies: Purchased independently by the individual, these policies allow for greater customization of coverage amounts and waiting periods for benefits to begin. They are more expensive than group policies but may offer additional features or options.

Long-term disabilities can be categorized into several types, including but not limited to:



Physical disabilities

Caused by injuries, accidents, or chronic illnesses affecting mobility, strength, or dexterity.

Mental disabilities

include depression, anxiety disorders, and schizophrenia which affect cognitive function, mood, or behavior.

Sensory disabilities

Impair one or more senses, such as vision, hearing, or touch.

Cognitive disabilities

impact cognitive functions like memory, attention, or processing speed, such as traumatic brain injury, dementia, or learning disabilities.

It is essential to understand the definitions and types of long term disabilities to determine the appropriate coverage and support needed for individuals with these conditions.

Causes and Risk Factors

Long-term disability can result from various causes, ranging from illness to injury. In this section, we will discuss some common causes and risk factors associated with long-term disability.

Some common causes of long-term disability include:

● Chronic illnesses, such as heart disease, cancer, and diabetes
● Mental health conditions, like depression or anxiety
● Neurological disorders, such as multiple sclerosis or Parkinson's disease
● Autoimmune diseases, like rheumatoid arthritis or lupus
● Workplace injuries or accidents
● Accidents or injuries sustained outside of work, like car accidents or falls

Several risk factors can contribute to the likelihood of developing a long-term disability. Some of these risk factors include:

Risk Factor



The risk of developing a long-term disability increases with age, as the chances of experiencing health issues and injuries increase.


Jobs that require heavy lifting, repetitive movements, or exposure to hazardous materials may increase the risk of experiencing a disabling injury or illness.

Family history

Individuals with a family history of certain illnesses or health conditions may be more likely to develop long-term disabilities.

Lifestyle factors

Smoking, excessive alcohol consumption, and a sedentary lifestyle can contribute to the development of various health conditions that may lead to long-term disability.

Identifying and addressing these risk factors is essential to reduce the likelihood of developing a long-term disability. Medical professionals can often provide recommendations and resources for managing and reducing these risks.

Eligibility for Long Term Disability Benefits

When seeking long term disability benefits, it is important to understand the eligibility requirements. This section will cover Qualifying Conditions, Waiting Period, and Benefit Duration.

Qualifying Conditions

A long-term disability must meet specific criteria to qualify for benefits. These conditions typically include:

● A medical condition that prevents you from performing your job
● Documentation from a licensed medical professional confirming the disability
● An inability to work for a specified period, typically six months or more

Each policy and insurer may have additional requirements for qualifying conditions.

Waiting Period

The waiting period, also known as the elimination period, is the duration between the onset of your disability and the start of your long-term disability benefits. Most policies have a waiting period of:

Short-term Disability

Long-term Disability

7-14 days

90-180 days

It is important to be aware of your policy's waiting period as it affects when your benefits will begin.

Benefit Duration

Benefit duration refers to the length of time that you will receive monthly benefits. Common benefit durations include:

● 2 years
● 5 years
● Up to age 65
● Lifetime

Note that each policy may have different benefit durations and may be influenced by factors such as your age, occupation, and insurance provider.

Applying for Long Term Disability Benefits

Applying for long-term disability benefits can be a complex and time-consuming. Understanding the requirements and deadlines is essential to ensure a smooth application process and maximize your chances of receiving the benefits you need.

Documentation Requirements

When applying for long-term disability benefits, providing thorough and accurate documentation is crucial. This includes:

● Medical records and reports
● Employment and income information
● A completed disability application form
● Any supporting documents, such as a letter from your physician

It's important to gather all necessary documentation before starting the application process to avoid delays and ensure a smoother process.

Filing Deadlines

Filing deadlines for long-term disability benefits can vary depending on the policy and specific situation. Some key deadlines to be aware of include:



30-90 days

Typical timeframe to file a claim after the onset of disability

180 days

Maximum timeframe allowed to file a claim under most policies


Deadline for submitting an appeal if your claim is denied

It's essential to be aware of and adhere to these deadlines to avoid jeopardizing your eligibility for benefits. Reach out to your insurance company or plan administrator for specific deadlines related to your policy.

Long Term Disability Insurance

Long Term Disability Insurance plays a crucial role in securing your financial future in the event of an injury or illness that prevents you from working for a prolonged period. Understanding the different types of policies available and their specific features is essential. This section will cover Group Policies, Individual Policies, and Policy Features.

Group Policies

Group Policies are commonly offered as a benefit by employers, providing coverage to employees at a lower cost than individual policies. The key features of group policies are:

● Lower premium rates due to shared risk among members
● Streamlined underwriting and easier acceptance criteria
● Portability of coverage depends on the employer and policy terms

Individual Policies

Individual Policies are bought directly from the insurer and offer personalized coverage based on your occupation, income, and health status. Highlights of individual policies include:

● Customized coverage tailored to your needs
● Annual premium charges without unexpected rate changes
● The payout period may vary depending on the policy terms
● Portable coverage that stays with you regardless of job changes

Policy Features

While selecting a Long Term Disability Insurance policy, consider these vital features:



Elimination period

The waiting period before benefit payments begin, typically ranging from 30 to 180 days.

Benefit period

The duration of benefit payments, from a few years to the policyholder's retirement age.

Benefit amount

The monthly payment, typically 60-80% of your pre-disability income.

Definition of disability

The insurer's criteria for determining if you are "disabled" and eligible for benefits (own occupation vs. any occupation).

Policy riders

Additional features or benefits that can be added to a policy, often at an extra cost.

Understanding these aspects of Long Term Disability Insurance policies will help you make well-informed decisions.

Managing and Living with Long Term Disability

Living with a long-term disability presents challenges that can impact various aspects of life. This section will discuss the key strategies to manage and adapt to a long-term disability, including financial planning, healthcare, and support services.

Financial Planning

Managing finances is essential to living with a long-term disability. Consider the following steps to ensure financial stability:

● Create a monthly budget to track income and expenses
● Apply for government assistance programs for people with disabilities
● Consult with a financial adviser for long-term planning and investments
● Have an emergency fund for unexpected expenses


Healthcare plays a crucial role in managing long-term disabilities. Ensure you have access to the necessary care and resources:

● Maintain regular communication with your healthcare providers
● Keep detailed records of medical appointments and treatments
● Explore healthcare service options and choose the appropriate insurance plan
● Stay informed about new treatment options and technologies

Support Services

Support services can significantly improve the quality of life for individuals with long-term disabilities. Consider these resources:

● Network with local support groups for emotional and practical assistance
● Seek help from vocational rehabilitation services for employment and training
● Utilize home care services for assistance with daily living activities
● Contact local agencies for accessible transportation options

Legal Rights and Protections

Understanding your legal rights and protections is essential when navigating long-term disability situations. This section covers two fundamental laws: the Americans with Disabilities Act and the Family and Medical Leave Act.

Americans with Disabilities Act (ADA)

The ADA is a federal law that prohibits discrimination against individuals with disabilities in all aspects of life, including employment. It applies to employers with 15 or more employees.

Under the ADA, employers are required to:

● Provide reasonable accommodations for qualified employees with disabilities, such as modifying workspaces or adjusting work schedules, unless it causes undue hardship for the employer.
● Not discriminate against job applicants or employees based on disability in the recruitment process, promotions, termination, or compensation.

For more detailed information on ADA and its implications, visit the ADA website.

Family and Medical Leave Act (FMLA)

The FMLA is another federal law that provides eligible employees with up to 12 weeks of unpaid, job-protected leave per year for specific family and medical reasons, including serious health conditions that result in long-term disability.

Eligibility criteria for FMLA:



Worked at least 1,250 hours in the past 12 months

Employs 50 or more employees within a 75-mile radius

Been employed for at least 12 months with the same employer

Is a public agency or public or private elementary or secondary school

While on FMLA leave, your employer must continue your health insurance coverage under the same terms as before your leave. They must also reinstate you to the same or equivalent position upon your return from leave.

For further information on FMLA, please visit the U.S. Department of Labor website.


Long-term disability insurance is crucial in providing financial security for individuals who cannot work due to an injury, illness, or chronic condition. Considering the potential risks associated with a prolonged inability to generate income, it is essential to be well-informed about the options available in long-term disability insurance.

When selecting a policy, consider factors such as the waiting period, benefit period, and coverage amount. Also, it is worth exploring employer-sponsored plans, individual policies, and government programs, such as SSDI, to determine the best possible combination that meets your individual needs and circumstances.

Having a comprehensive long-term disability insurance policy in place can provide much-needed peace of mind and financial stability for you and your loved ones in challenging times.