Conditions That Frequently Qualify for Long-Term Disability Benefits 

Individuals going through the stressful process of submitting their claims for coverage under long-term disability insurance (LTD) policies can often find themselves overwhelmed by the requirements applied to determine eligibility. The application process can sometimes be easier for those who have one of the several common conditions qualifying for LTD under almost all circumstances, but many medical conditions eligible for long-term disability are less widely-known. Additionally, some conditions may make an insurance provider’s LTD qualifying illnesses list only when the symptoms meet certain criteria for severity. The process of proving disability can be especially difficult for individuals struggling with their health, in many cases it may be helpful to seek external legal advice and support. 

Types of Long-Term Disability Insurance: Own Occupation vs. Any Occupation Plans

Many individuals who are offered disability insurance through their employers, or considering the purchase of private disability insurance on their own, may at first instinctively focus on the distinction between short-term disability vs. long-term disability insurance policies. This distinction is indeed important, not least because many long-term disability policies include provisions stipulating that short-term disability insurance must be exhausted before the policyholder can submit a claim for coverage under the LTD plan. 

Other factors in plan selection may include the percentage of former income replaced, and any restrictions or limitations on the duration of coverage. Generally speaking, plans that offer to replace a higher percentage of the policyholder’s income will be accompanied by comparably higher premiums. Some LTD plans will stipulate payment over a period of years, while others may offer coverage until the policyholder enters retirement age. All of these factors may be important considerations for individuals who have the option to choose between plans.

In determining the scope of future benefits eligibility, however, one of the most significant factors may be the difference between “own occupation” and “any occupation” policies. The distinction can have an impact on whether the policyholder’s claim is approved because these two types of policies can differ sharply in the degree of disability the individual is required to prove in order to receive benefits. The degree of disability is in turn frequently  linked to the underlying condition responsible for a decline in the individual’s health.

Own Occupation Policies: How They Impact Long-Term Disability Eligibility

“Own occupation” long-term disability insurance policies are designed to replace a portion of the policyholder’s income if the individual is required to leave the job they held prior to becoming disabled. Because the demands of employment can differ significantly not only by industry but by position and even workplace culture, own occupation LTDs may provide benefits even if the policyholder is still able to perform some types of work at the time they file their claim. 

According to the Consumer Federation of America (CFA), many policies offer an initial “own occupation” period, during which the policyholder is expected to adapt to his or her new condition by searching for a new job that does not require the tasks or activities the individual is no longer reliably able to perform. Often this job search may be accompanied by skills retraining, particularly if the individual previously worked in a highly specialized occupation.

After the initial own-occupation period, it is very common for long-term disability policies to transition to the “any occupation” model. Key points to look for in your policy documents include how unfitness for former occupation will be assessed, the type of medical documentation that will be needed to prove the claim, and whether own-occupation income replacement is permanent vs. subject to expiration after a predefined period. For policies that contain sunset provisions for own-occupation coverage, identifying the duration of the own-occupation coverage period and any specific requirements the policyholder must meet to maintain coverage throughout this period will also be important.

Any Occupation Policies: How Total Disability Is Determined and What It Means

The threshold for disability determinations in own-occupation disability claims tends to be lower than that required to qualify for coverage under an “any occupation” policy, primarily because not all jobs are equally demanding. What is easy for one person is frequently very hard for another. 

Long-term disability insurance policies that provide benefits only if the policyholder is no longer able to maintain consistent employment in any occupation are built on this basic principle. Insurance companies expect individuals who become disabled through illness or injury to explore their options for transitioning to a new role or new career before turning to a long-term disability policy to replace the income from their former job. 

Policies that provide an initial period of own-occupation coverage to individuals who are unable to continue in the jobs they held prior to the decline in their health, acknowledge that such transitions take time. As a result, they often require substantial background work in preparing for a new career and finding a first job suited to the limitations now imposed by their personal health.

LTD Qualifying Conditions List

Many insurance providers will have a list of conditions that are considered presumptively qualifying. This means that  the conditions are known to be disabling, and individuals diagnosed with those conditions may experience an expedited processing of their long-term disability claims. The specific list of conditions that may qualify will vary, depending on the insurance company and the terms of the individual policy.

The list of conditions that qualify for own occupation vs. any occupation coverage will not necessarily be different, even for policies that include both types of coverage at different stages through the life of the policy. However, some conditions can vary significantly in their severity, and in that case the question of whether a condition is totally disabling vs. partially disabling in a particular case may determine whether an individual claim is approved.

SSDI Qualifying Conditions

Particularly for individuals filing claims under any-occupation disability plans, both the list of conditions the Social Security Administration (SSA) considers presumptively qualifying and the definition of disability the SSA uses in determining individual applicants’ eligibility for benefits under Social Security Disability Insurance (SSDI) can often be valuable resources. While not all private long-term disability insurance policies apply exactly the same rubric as the SSA, many any-occupation disability policies will closely approximate SSDI eligibility guidelines. The SSA’s list of conditions presumptively qualifying for SSDI benefits can therefore be considered a useful as a starting point for an LTD qualifying illnesses list. Additionally, the agency’s description of disability standards forms a similarly useful point of reference for understanding common conditions qualifying for LTD.

Social Security Definition of Disability

For the purposes of determining SSDI eligibility, the SSA considers an individual to be disabled if he or she experiences mental or physical impairment that are sufficiently severe to prevent the individual not only from continuing in his or her pre-disability occupation, but also to prevent the same person from working in another position. “Working” in this case is dependent on a second definition, of “substantial gainful activity” (SGA), which instead of hours worked or benchmark tasks achieved is based on a monthly threshold for earned income. 

The definition of disability is also tailored to account for the age, prior work experience, and educational preparation of the SSDI applicant. Occupations are limited to those that are available “in significant numbers” either in the area where the individual already lives, or across “several” parts of the United States.

Social Security List of Qualifying Conditions

The SSA’s Blue Book list of qualifying conditions is divided into categories. Within these categories, which include groupings for neurological disorders, musculoskeletal disorders, immune system disorders, mental disorders, and cancers, a number of specific diagnoses are listed. Some common disorders that are listed within Blue Book categories include:

• Systemic lupus erythematosus (commonly called lupus)
• Schizophrenia spectrum or other psychotic disorder (diagnoses in this sub-category are subject to medical assessments for severity, as not all individuals experience the same symptoms or degree of impairment)
• Various types of lymphoma, subject to considerations regarding the duration of prescribed treatment and patient prognosis (particularly with respect to whether the cancer is expected to be terminal, or whether the treatment protocol is projected to last a year or longer)

Many more diagnoses, across the several illness categories, are also listed. In addition to an initial diagnosis, many of the listed illnesses will need to be supported with medical assessments documenting the relative severity of impairment caused by the disease in each individual applicant’s case. 

Medical Conditions Eligible for Long-Term Disability

As the SSA further specifies, the list of impairments does not cover all potential disabilities; instead, it provides a shorthand of sorts, facilitating evaluation in cases of medical conditions that commonly result in a degree of impairment sufficient to warrant SSDI approval. SSDI approval may or may not directly impact LTD decisions. Some long-term disability insurance plans do consider final SSDI determinations in their own claims evaluations, whereas others may not rely on SSDI decisions in evaluating whether to approve an individual’s LTD claim, even if they require the policyholder to provide proof that they have applied for Social Security disability. Because the bar Social Security sets for disability is high, as a general rule the SSA’s list of qualifying conditions shares considerable overlap with medical conditions eligible for long-term disability.

Learning More About Your Options For Long-Term Disability Benefits 

Understanding which conditions frequently qualify for long-term disability benefits can make the claims process feel less overwhelming and help you prepare the strongest possible application. Whether your diagnosis falls within a commonly accepted category or involves a less familiar condition, gathering clear medical evidence and understanding your policy’s requirements are critical steps. Because long-term disability insurance policies and Social Security Disability Insurance rules can differ in important ways, it is always wise to review your options carefully and seek legal guidance when needed.