Long-term disability insurance (LTD) provides benefits to replace a percentage of a policyholder’s lost income if he or she becomes unable to work due to illness or injury. Conditions that suddenly and dramatically impact an individual’s ability to work can be personally devastating, but may result in relatively straightforward claims. Because progressive conditions often start gradually and reduce an individual’s working ability over months or even several years, LTD policies for progressive medical conditions need to take a more complex set of factors into consideration.
Long-term disability coverage for worsening conditions can help to buffer the financial losses that result from necessary reductions in working time and pay rates over time, but progressive illness accommodation in LTD is not always a given. Both the extent of coverage and the range of options for tailoring accommodations to your personal needs can vary from one policy to another. Familiarizing yourself with some of the most common options in LTD policies for progressive medical conditions can make it easier both to choose a policy and to navigate the requirements for claiming long-term disability coverage for worsening illnesses under the terms of a policy you already have.
Progressive Conditions and LTD Benefits: Long-Term Disability Coverage for Worsening Illnesses
Many Americans are deeply concerned about the possibility of developing progressive conditions. “Progressive” is a term medical professionals apply to illnesses that become worse over time. Unlike most infections or injuries, these conditions do not follow a pattern in which symptoms appear, perhaps get worse for a while, but then gradually improve as the patient recovers. Progressive conditions are usually considered irreversible, meaning that there is no known cure and patients diagnosed with these conditions are not expected to recover.
Even though progressive illnesses are generally incurable, they are not always disabling when first diagnosed. Treatments for these conditions are usually aimed at slowing the progression of the disease. A highly effective treatment may slow the progression enough to add several years to a patient’s life. Most of the time, however, any progressive condition is considered to be a terminal diagnosis. The life expectancy associated with a progressive condition depends on not just the specific diagnosis, but the stage at which the condition is diagnosed and the patient’s own age when the diagnosis occurs.
Common Progressive Conditions
Progressive conditions can range from those so well-known they are a common source of worry to others so rare that most people have never even heard of them. The most common progressive conditions are not necessarily the most rapidly disabling, but for obvious reasons they are the ones with which anyone is more likely to be diagnosed over the course of a lifetime.
Some of the most widely recognized progressive conditions include:
- ALS
- Amyotrophic lateral sclerosis (ALS)
- Parkinson’s Disease
- Multiple Sclerosis
Some of these conditions, such as Alzheimer’s Disease, are much more common in people who are already at or near retirement age. Others, such as ALS, are often diagnosed in much younger people. Age at diagnosis can affect both your need for progressive illness accommodation in LTD and your overall life expectancy after the condition is recognized in your case.
Are Pre-Existing Conditions Covered by Long-Term Disability Insurance?
One of the most frustrating tragedies affecting many people with progressive conditions is that diagnosis is often delayed, sometimes for years. In addition to the fact that these delays necessarily mean forestalling the initiation of treatments aimed at alleviating current symptoms and slowing the progression of disease, they also lead to an increased risk that the disease will be flagged as a pre-existing condition and therefore potentially excluded from LTD eligibility.
Look-Back Periods
Insurance companies often use medical records of any tests or treatments prescribed during the “look-back” period for symptoms that could be related to the condition that has led someone to file for disability as grounds for denying a claim on the basis of a pre-existing condition. However, look-back periods and long-term disability coverage for worsening conditions do vary from one plan to another, so always be sure to check the terms of your specific policy.
Policy-Specific Terms
People who receive the life-altering diagnosis of a progressive condition often have a number of questions regarding their futures. Beyond medical concerns, some of the most common questions revolve around how to prepare for disability and what their options are. Because it can be hard to get long-term disability coverage for worsening illnesses that are already diagnosed prior to selecting an LTD plan, those options are likely to depend to some extent on whether an individual already has progressive illness accommodation in LTD benefits at the time of diagnosis. If you have recently been diagnosed with a progressive condition, reviewing the terms of your specific insurance policy is an important step toward determining the options available in your situation.
Choosing LTD Policies for Progressive Medical Conditions
Individuals who are not yet grappling with the consequences of a diagnosis may have a wider range of options to explore. That potentially opens up opportunities, but it also underscores the importance of making decisions.
Progressive Illness Accommodation in LTD Group vs. Individual Plans
If your employer is offering long-term disability insurance, make it a point to review the policy’s terms for progressive illness accommodation in LTD benefits. If you are selecting a long-term disability insurance policy on the consumer market, you may be able to filter your searches and inquiries to LTD policies for progressive medical conditions.
Progressive Illness Accommodation in LTD by Design
Some companies in the insurance industry offer policy options that are designed precisely to address concerns around long-term disability coverage for worsening illnesses. These policies may have provisions built in to account for the fact that disability resulting from a progressive condition often develops gradually, with the patient slowly finding specific tasks or types of activities more and more difficult. In addition to perceived difficulty level, they may also experience a higher and higher error rate during execution.
Progressive Illness Accommodation in LTD – Gradual Withdrawal From Job Responsibilities
Depending on the type of task and how critical it is to the individual’s job function, these error rates may be inconveniences tolerated by employers or may present workplace health and safety concerns that even the most understanding employers have a responsibility to eliminate due to the risks they pose to all involved. Recognizing this variability, some LTD policies for progressive medical conditions offer tailored options designed to let an individual with declining capabilities withdraw from the workforce in stages over a period of months to years.
The goal in these cases is to ensure that individuals can work with their employers to gradually reduce tasks and working hours in pace with the development of their conditions. Usually the process will entail “reasonable accommodations” under the Americans with Disabilities Act (ADA) that remain in force for a period during which the employee is able to continue working with appropriate support, while the long-term disability coverage for worsening illnesses provides an “off-ramp” to support the individual’s financial security. These can be attractive options to many workers, but be mindful of the details set out in your policy terms, as some policies only offer accommodations when an individual’s decrease in earnings exceeds a specified threshold within a designated period of time.
Riders – Customizing LTD Policies for Progressive Medical Conditions
In addition to the accommodations for progressive medical conditions that may be built into some long-term disability policies, some insurance companies offer specialized add-ons, called “riders,” that policyholders may be able to use to expand and customize their long-term disability coverage for worsening illnesses. If you have insurance through an employer that lacks the kind of flexibility that may be needed to structure progressive illness accommodation in LTD, it may be worth checking to see whether the insurer offers employees on group plans the option to purchase this type of rider to build LTD policies for progressive medical conditions.
Even if you are purchasing a policy directly from an insurance company as an individual consumer, you may find it useful to conduct a price comparison and evaluate whether a rider added to a minimal plan would be more cost-effective for your concerns than purchasing an all-inclusive policy to account for progressive illness accommodation in LTD terms.
LTD Policies for Progressive Medical Conditions: Own Occupation Coverage
Some common concerns around long-term disability coverage for worsening illnesses center on the specific demands of an individual’s chosen profession. These demands vary widely, but the concerns themselves tend to take shape around the interplay of three main factors:
- The dominant initial and early-stage symptoms of the diagnosed illness
- The speed of disease progression
- The set of abilities most crucial to the individual’s profession
The greater the overlap between the skills and abilities affected by early symptoms of a given disease and the skills and abilities central to an individual’s profession, the sooner that condition is likely to disable the patient from their current job role. The faster the condition progresses, the sooner the disease is likely to disable the patient from working regardless of their current role.
Own Occupation vs. Any Occupation: Structuring LTD Policies for Progressive Medical Conditions
In long-term disability insurance terms, “own occupation” coverage refers to benefits that are available when the policyholder is no longer able to continue working in his or her current job role. “Any occupation” policies only provide benefits when the policyholder is no longer able to continue working in any position. Some insurance companies offer own-occupation policies tailored to specific professions, often with specific long-term disability coverage for worsening illnesses built into the policy terms. Physicians tend to form a demographic frequently targeted with this type of policy, owing to the relatively high income potential in certain medical fields and the relatively low transferability of the skills involved in the highest-earning positions. If you work in a job role that requires highly specialized training, comparing policies with an eye toward this type of progressive illness accommodation in LTD benefits may be a worthwhile endeavor.
Own-to-Any Occupation Coverage: Potential Problems for Progressive Illness Accommodation in LTD
Many policies combine the two types by offering a limited period of own-occupation coverage, after which benefits eligibility is determined on an any-occupation basis. These own-to-any policies are intended to provide a transitional period in which someone who has been forced to leave their previous job can adapt and acquire job skills that prepare them for work that fits within their altered capabilities. They can be enormously helpful under certain circumstances, but the nature of a progressive condition means that any new set of skills an individual is able to master will have a limited window of usefulness. As a result, own-to-any occupation plans have often painful limitations as LTD policies for progressive medical conditions.
Know Your Priorities and Options for Long-Term Disability Policies Regarding Progressive Conditions
Progressive medical conditions are both common and devastating. Unfortunately, many insurance policies offer limited progressive illness accommodation in LTD plans. Some of the choices available in your situation may depend on whether you have a group plan vs. one purchased individually. For individuals on employer-sponsored group plans, the coverage for potentially pre-existing conditions can sometimes be more robust than on individual plans, and initial approval of enrollment can sometimes be easier. That said, these policies may also offer more limited flexibility and options for customization than those available on the individual market.
Always evaluate a policy’s terms regarding long-term disability coverage for worsening illnesses carefully. You may want to pay attention to whether the policy offers progressive illness accommodation in LTD by providing a gradual increase in benefits as working ability and income decrease. As with any other type of long-term disability insurance, LTD policies for progressive medical conditions are likely to require extensive documentation before approving claims. Take comprehensive notes throughout the process, and do not hesitate to seek professional assistance in selecting a policy or in submitting your claim.
