Long-Term Disability Qualifications

What Is Long-Term Disability Insurance?

Long-term disability (LTD) insurance is a type of insurance policy that can provide financial benefits to an employee who is unable to work for a long period due to an accident, illness, or injury.

This type of insurance coverage provides the employee with a portion of their income while they’re absent from work — regardless of whether or not their injury occurred in the workplace.

Unfortunately, insurance companies may wrongfully deny your long-term disability claim in an effort to maximize their profits.

Since 1979, the attorneys at Sokolove Law have been working to help those who were wronged through no fault of their own. We can handle the legal legwork for you, so you can focus on your health and loved ones.

Long-Term Disability Requirements

Generally speaking, you may qualify for long-term disability benefits if you:

• Pay for a long-term disability insurance plan
• Have a medical condition that qualifies as a disability under your insurance policy
• File a claim for long-term disability with your insurance company

Even if you meet the requirements for long-term disability, your claim may still be wrongfully denied.

If this happens, call Sokolove Law as soon as possible at (800) 995-1212.

“Thanks to Sokolove Law, we won the battle against the insurance company. Now, I have the support and financial security I need to focus on my health and well-being. I’m grateful for their help and would recommend Sokolove Law to anyone facing a similar struggle.”
– Engineer in D.C. with a Denied Disability Claim

List of Medical Conditions That Qualify for Disability

Many people think long-term disability insurance is for people who have been physically injured in an accident and are unable to work as a result of their injury.

While this may be true, there are many medical conditions that may also entitle you to receive disability payments.

Some of the medical conditions that may qualify for long-term disability benefits include:

• Anxiety
• Arthritis
• Autism spectrum disorder
• Bipolar disorder
• Cancer
• Carpal tunnel syndrome
• Cerebral palsy
• Chronic fatigue syndrome (CFS)
• Crohn’s disease
• Degenerative disc disease
• Depression
• Diabetes
• Epilepsy
• Fibromyalgia
• Heart disease
• Herniated disc
• HIV/AIDS
• Lupus
• Multiple sclerosis (MS)
• Post-traumatic stress disorder (PTSD)
• Spine disorders
• Stroke

The above list of medical conditions is not exhaustive, and qualifying conditions vary from policy to policy.

Before filing a long-term disability claim, it’s important to understand how your insurance company defines a disability. This information can be found by carefully reading your insurance policy.

If you believe you were wrongfully denied long-term disability insurance, reach out to our team today. We can help you learn about the different avenues available to you.

Categories of Medical Conditions for Disability

There are many different medical conditions that may qualify for LTD, and most can be categorized in one of the following categories.

Learn more about qualifying medical conditions for long-term disability and how insurance companies may evaluate these conditions.

Alzheimer's Disease & Dementia

Alzheimer’s and dementia can lead to a decline in cognitive abilities, including impairments in:

• Behavior
• Memory
• Reasoning
• Thinking

Long-term disability benefits may be available to help individuals diagnosed with Alzheimer’s or dementia pay for their expenses once they are no longer able to work and receive a paycheck.

Amyotrophic Lateral Sclerosis (ALS)

ALS, also known as Lou Gehrig’s disease, is a neurodegenerative disease that attacks the nerve cells controlling voluntary muscle movement.

Because this condition typically progresses quickly and diminishes an individual’s ability to perform essential functions like speaking, swallowing, or moving, patients often qualify for LTD.

Anxiety & Depression

A wide range of mental health conditions, like major depressive disorder, bipolar disorder, and schizophrenia, may be covered by long-term disability insurance. In severe cases, these conditions can hinder an individual's ability to maintain regular employment.

Arthritis, Back Pain, and Other Musculoskeletal Disorders

Musculoskeletal disorders are the leading cause of long-term disability claims, according to the Council for Disability Awareness. These claims can encompass back pain, arthritis, joint disorders, and more.

Musculoskeletal disorders may lead to chronic pain and physical limitations that prevent individuals from performing their regular work duties over an extended period of time.

Cancer

Cancer is the second-most common reason for long-term disability claims, according to the Council for Disability Awareness. People with cancer often require treatments like chemotherapy or radiation, which may cause side effects that hinder a person's capacity to work for an extended period. Disability insurance can offer financial support during this challenging time.

Chronic Fatigue Syndrome (CFS)

Chronic fatigue syndrome, also known as myalgic encephalomyelitis (ME), is a complex and often debilitating medical condition characterized by severe and persistent fatigue that’s not improved by rest.

To qualify for long-term disability benefits, policyholders may need a formal diagnosis of CFS that has been made only after other medical and psychiatric causes of chronic fatigue have been excluded.

Chronic Pain

In order to receive long-term disability for chronic pain, the pain usually needs to be linked to an underlying condition. Since pain can be subjective and difficult to prove, medical records that identify the root cause of your pain — like a back injury or carpal tunnel syndrome — may be required to secure benefits.

At Sokolove Law, we recovered $316,000 for a client with chronic pain from fibromyalgia and lupus after their original Unum claim was denied.

Many insurance companies will also check to see if you are seeking consistent medical treatment for your chronic pain to further validate how much your condition impacts your day-to-day life.

COPD & Respiratory Disorders

Respiratory disorders like chronic obstructive pulmonary disease (COPD) or severe asthma may be eligible for long-term disability insurance since breathing difficulties can reduce someone's capacity to engage in physically demanding work or activities.

Crohn's Disease & Other Digestive System Disorders

Digestive system disorders like Crohn’s disease, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and chronic liver disease can cause debilitating symptoms, potentially affecting an individual's ability to work regularly.

Insurance companies will evaluate the effects of treatment on the severity and duration of digestive system disorders before determining if policyholders qualify for long-term disability benefits.

Diabetes & Endocrine Disorders

Endocrine disorders cause a hormonal imbalance in the body. Diabetes mellitus, thyroid gland disorders, and hyperglycemia are just a few of the endocrine disorders that may qualify for long-term disability coverage.

Epilepsy, Parkinson’s, and Other Neurological Disorders

Long-term disability insurance often includes coverage for conditions that cause significant neurological impairment, leading to challenges like difficulty moving and communicating.

While there may be treatment options for some neurological disorders, to qualify for LTD, your condition must continue to limit your ability to work even after regularly taking prescribed medications or following other treatment plans.

Since neurological disorders affect physical and mental functioning to varying degrees, the insurance company will review your claim closely to determine if your condition interferes with your daily work activities enough to qualify.

Hearing & Vision Impairment

Conditions affecting special senses like hearing, vision, and speech may also qualify for LTD coverage, as these can significantly impact a person's ability to communicate and work effectively. Documentation showing the extent to which these abilities are diminished is required when determining eligibility benefits.

For example, many insurance companies note that vision loss must reach the level of statutory blindness, which is defined by the SSA as, “central visual acuity of 20/200 or less in the better eye with the use of a correcting lens.”

HIV/AIDS and Immune System Disorders

Long-term disability insurance may cover disorders that cause immune system dysfunction — like HIV/AIDS, vasculitis, or scleroderma —as these can lead to substantial physical limitations as they progress.

Unfortunately, common symptoms of immune system disorders are often considered subjective, like pain and fatigue. This can make it difficult to prove just how debilitating the condition actually is, but statements from your doctor, lab results, and more can help make your case for LTD benefits.

Get a free case review now to find out if our long-term disability lawyers can file an LTD appeal and pursue compensation on your behalf.

Rheumatoid Arthritis & Other Autoimmune Disorders

Autoimmune disorders like rheumatoid arthritis (RA) cause the immune system to mistakenly attack the body's own tissues, leading to inflammation and damage. These conditions can result in chronic pain, joint deformities, and significant functional limitations.

Some autoimmune disorders may not always respond well to treatment, and the effects of the condition can persist despite medical intervention. This can further support your claim for long-term disability benefits.

Stroke & Heart Disease

Long-term disability insurance may cover cardiovascular disorders like heart failure, coronary artery disease, heart arrhythmias, and transient ischemic attacks (TIAs) especially if these conditions lead to significant limitations in physical activity and work performance.

Insurance companies may reevaluate cardiovascular claims by, for example, asking for updated information months after your heart attack to see if your ability to work is still impacted.

Traumatic Brain Injury

TBIs can result in a range of cognitive, physical, and emotional impairments. Victims of traumatic brain injuries may be able to access long-term disability benefits, depending on the severity of the injury and its impact on their ability to work.

Neurological exams, statements from medical professionals, and observations by supervisors and family members may all be used to determine whether or not someone with a traumatic brain injury qualifies for LTD.

Filing a Long-Term Disability Insurance Claim

Remember, it’s in the insurance company’s best interest to prove that you do not qualify for long-term disability benefits under the terms of your policy. You can be confident that they will ask for every last detail of your condition, including lab tests, medical records, and other documentation.

Your insurer may even try to deny your long-term disability claim by misclassifying your illness or insisting that your disability is a psychological condition when it’s really a chronic disease.

Thankfully, if your disability insurance claim is denied, Sokolove Law may be able to help you appeal the result.

“Sokolove Law understood what I was going through and treated me like family. They knew the ins and outs of disability law, and they were ready to fight for my legal rights. Their dedication and hard work were unmatched.”
– Massachusetts Mechanic with a Denied Disability Claim

Why Hire a Long-Term Disability Lawyer?

After a denied long-term disability claim, many consumers feel confused and defeated at the thought of the time and effort needed to make the insurance company pay out.

Working with a long-term disability claims attorney who can advise you and handle the appeal process on your behalf can help give you peace of mind and make the legal process easier on you during this difficult time.

Don’t risk losing your appeal on a technicality or by not having the right information available, especially not when Sokolove Law may be able to help.

Fight Back Against a Denied Long-Term Disability Claim

If your disability claim has been denied but you feel you still qualify for benefits, don’t take “no” for an answer. You may be able to fight back against the insurance company’s decision and pursue the benefits you’re entitled to.

For over 40 years, Sokolove Law has helped clients across the country secure compensation for their injuries. Our experienced staff will listen to the details of your claim and provide you with information about your legal rights.

We can help you take the next steps toward justice. Fill out our contact form or call (800) 995-1212 now to receive a free, no-obligation case review.

Long-Term Disability Qualification FAQs