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What Medical Conditions Qualify for Long-Term Disability?

Getting approved for long-term disability (LTD) benefits can be a difficult and frustrating process. Policyholders often struggle to figure out what medical conditions are covered, what conditions are excluded, and how severe symptoms have to get before the insurance company will approve the claim.

You should not feel bad if you find it hard or impossible to figure out how your long-term disability policy works. Most policyholders end up frustrated when they try to interpret their LTD policy. That is because these policies:

  • Are written in confusing, dense legal language
  • Each have their own unique definition of disability and their own list of limitations and exclusions
  • Leave loopholes and room for interpretation, so the insurance company may deny benefits even if you feel very confident your medical condition is covered

The best way to figure out whether a specific condition is covered is to have an experienced long-term disability lawyer review your insurance policy. In case you still want to do more research about your claim, this article will provide some general insight into what kinds of medical conditions are typically covered, common difficulties claimants face, and how an experienced disability attorney can help.

What Does My Policy Cover?

In general, your long-term disability insurance benefits include any condition that:

  1. meets your policy’s definition of disability; and
  2. is not specifically excluded by your policy.

Before we talk more about which conditions might qualify, we will debunk some common myths about long-term disabilities.

  • Myth #1: The disability must come from a physical injury. Many people mistakenly believe that to qualify for long-term disability, they need to have suffered a physical injury to their body. In fact, almost all policies accept that a wide variety of illnesses qualify as disabling. Covered illnesses often include conditions such as:
    • infectious diseases
    • neurological disorders
    • autoimmune disorders
    • digestive disorders
    • mental and psychological disorders
  • Myth #2: The disability must be specifically listed in your insurance policy. Although your policy may have a list of conditions that automatically qualify, it will not contain a “master” list of every possible injury or disease that could qualify. In many cases, your disability status may not be the result of any one single illness or injury. Instead, you may end up disabled because of a combination of medical conditions and injuries that leave you unable to work.
  • Myth #3: A diagnosis automatically proves disability. The condition of vision loss provides an example of why this is not true. Even though loss of vision can cause total disability, not everyone with vision loss becomes unable to work. Whether you qualify for LTD benefits due to vision loss (or any condition) will depend on factors such as the severity of your symptoms, the definition of disability in your policy, and the kind of work that you do.

The Definition of Disability

Long-term disability insurance policies will generally use one of two definitions of disability:

  • Own occupation: An own-occupation policy covers you if your symptoms prevent you from fulfilling the work obligations of the current job that you are trained to perform. You can work a different type of job and still receive full disability benefits.
  • Any occupation: Under an any-occupation policy, symptoms must leave you totally disabled and unable to perform any job to which you are reasonably suited. This is a much tougher standard than an own-occupation policy. The any-occupation definition can result in denied benefits and claimants being forced to take lower-paying, less fulfilling work.

Unfortunately, most long-term disability policies use the any-occupation standard. If you have the option, we strongly encourage you to purchase any-occupation coverage, especially if you earn a high wage or work in a highly skilled profession (doctors, dentists, attorneys, etc.).

Some long-term disability policies initially offer own-occupation coverage but transition to the any-occupation standard after a certain amount of time. If you are not aware of your policy conditions, this transition could lead to benefits being unexpectedly cut off even after being previously approved.

Partial List of Medical Conditions That May Be Covered by Long-Term Disability Insurance

Since there is no master list of qualifying conditions that can be approved for long-term disability, it is impossible to create a complete list of potentially disabling conditions. Remember: whether your condition is listed below or not, you can potentially receive benefits—if your condition is not on the policy’s list of excluded conditions, and you can show that your symptoms or condition are severe enough to meet the policy’s definition of disability.

Many of the long-term disability claim conditions we can handle at Bryant Legal Group are listed below. You can select any of the clickable entries to learn more about the claims process for that condition.

Automatically Qualifying Conditions

Under normal circumstances, a disability insurance company will carefully scrutinize your claim before making an eligibility determination.

However, some conditions are so obviously disabling that they may automatically qualify for approval under your insurance policy. You will not need to demonstrate the extent, nature, or impact of the injury if you have been disabled by one of these conditions. Automatically qualifying conditions usually include:

  • Amputation
  • Total deafness
  • Total blindness

However, keep in mind that policy language can vary significantly. And you could still be involved in a dispute with the insurance company over what should be an automatically qualifying condition. For example, the definition of “total” hearing loss (versus profound or near-total hearing loss) may be somewhat subjective.

Common Limitations and Exclusions

Many long-term disability policies come with limitations or exclusions for specific conditions. Some of the most common limitations and exclusions include:

  • Pre-existing conditions. Different policies apply different rules for pre-existing conditions, so you will need to check your specific policy language. For example, your plan may deny disability insurance claims if you received treatment for a condition 180 days or fewer before obtaining coverage and make a disability claim for that condition within the first 12 months of coverage.
  • Mental health conditions. Although depression, anxiety, and other mental health-related medical conditions qualify for disability insurance under most policies, it is also common for policies to limit long-term disability benefits for these conditions to just one or two years. Once you reach this deadline, your benefits will end regardless of whether your symptoms still prevent you from working.
  • Other illnesses and conditions with “self-reported” symptoms. Conditions with physical symptoms that are hard or impossible to diagnose with medical tests—for example, fibromyalgia or chronic fatigue syndrome—are often limited by a maximum benefit period of one to two years.
  • Alcohol and substance abuse. Many disability insurance policies will only cover substance abuse disorders for a limited time. Some policies do not cover these conditions at all.
  • Workplace injuries. If you are hurt on the job, any resulting disability should be covered by your workers compensation policy, not short- or long-term disability insurance coverage.

Your policy may contain other exclusions as well. Some LTD policies exclude injuries related to suicide attempts, self-inflicted injuries and illnesses, pregnancy-related conditions, and even acts of war. Since each policy is different and most policies are very complicated, your best option is to work with a long-term disability attorney to file a claim.


Navigating the Long-Term Disability Claims Process Can Be Challenging

It is not easy to build a comprehensive disability insurance claim. The process of building the claim and then fighting the insurance company to approve it takes patience, dedication, and skill. Disability insurance companies care about profit, not your well-being, and they will not hesitate to deny claims that lack the required documentation and medical evidence.

To prove your case, you may need to provide evidence such as:

  • Extensive medical records documenting your condition
  • Expert opinions and notes from physicians and other professionals familiar with your illness or injury
  • Employee statements about your work requirements and your ability to work or maintain gainful employment
  • Proof that you are continuing to follow all your doctor’s orders and are doing everything you can to get better (or that no more can be done to regain your ability to work)
  • A journal of your daily symptoms.

If the insurance company can find any basis to reject your claim, they will most likely do it. You can expect a denial of benefits if your application is missing any documents or evidence. Reasonable claims, in which the claimant is very likely disabled, get denied all the time on technicalities.

Because the LTD claim process is complicated and strict, it is critically important to work with a long-term disability attorney if you are currently applying for benefits—especially if you are appealing a ruling after being wrongfully denied. Insufficient evidence, insurers acting in bad faith, or even careless mistakes can keep you from the benefits you desperately need. But an experienced attorney can go through your policy with you, help you assemble the medical evidence you need to support a disability ruling, and hold the insurers accountable to pay what they owe.

Bryant Legal Group: Chicago’s Premier Long-Term Disability Attorneys

The attorneys at Bryant Legal Group have decades of experience helping people with disabilities navigate the long-term disability claims process and receive benefits they badly need. Our law firm exclusively represents policyholders—never the big insurance companies—and our lawyers will work hard and fight hard to achieve the best possible outcome for your claim.

If you are unable to work due to illness or injury, contact us today for your free consultation. Call (312) 818-3648 or complete our online form to get started.