If you need to apply for long-term disability insurance (LTD) benefits, you are likely already frustrated with the difficulties of adapting to your new situation. You may also be under significant financial strain. All of these factors can make navigating the LTD claim filing process even more difficult than the multiple requirements imposed by most insurance policies would make it. Following a step-by-step LTD application guide can help by clarifying the essential elements of that process to apply for long-term disability benefits. As challenging as this period of your life may be, understanding how to apply for long-term disability insurance benefits can offer you a roadmap and plan of action as you venture into unfamiliar territory.
What Are the Steps of a Disability Application?
The exact procedures you may need to go through to apply for long-term disability benefits will depend on the policy requirements. Additionally, you may have somewhat different requirements for communicating with your employer’s human resources (HR) department about your application based on whether your LTD is a benefit provided by your employer vs. a policy you purchased independently.
Keeping these minor variations in mind, there are a few predictable steps almost anyone can expect to navigate as part of their LTD claim filing process. Following a step-by-step LTD application guide can make an often-complicated process a little less stressful. The fundamental steps typically include:
- Consulting with your medical care team
- Attempting or ruling out possible workplace accommodations that would allow you to remain in your current role or return to work once short-term disability insurance (STD) benefits expire
- Reviewing your policy’s eligibility criteria, submission timelines, and accepted forms of documentation
- Collecting medical evidence and ensuring that it is presented in forms of documentation considered acceptable under the terms of your policy
- Meeting all required deadlines
While not technically a step in the process, you will also generally want to keep an independent record of what you have submitted and when. Logs of your symptoms throughout the process may also become a useful point of reference if you later need to file an appeal.
Consult With Your Healthcare Team
In most cases, a person setting out to follow a step-by-step LTD application guide will already have gone through at least a few discussions and evaluations with healthcare professionals as part of the process to apply for STD benefits. However, if you are nearing the end of your STD benefit period and the symptoms for which you initially sought those benefits have not improved to the point where you feel able to return to work, you will usually want to have some honest conversations with the medical professionals involved in your care before you file the first piece of paperwork necessary to apply for long-term disability benefits.
Physicians and other healthcare professionals play a crucial role in not only treating the medical conditions that can lead to disability, but also documenting the progression of symptoms in a specific patient. Healthcare providers are often in a unique position to describe the medical standard of practice as it applies to an individual situation, and provide key evidence regarding a patient’s adherence to recommended treatments.
Long-term disability insurance companies will usually want to see evidence that an individual initiating the LTD claim filing process has been following all of the recommended treatment protocols and “doing their part” to recover so that they can return to work. Even if that is not a realistic possibility in your situation, the members of your medical team are likely going to be your first source of evidence for why a return to work is out of your reach.
Evaluating Potential Disability Accommodations
Another reason why it is important to begin by communicating honestly with the healthcare professionals closely involved in the treatment and management of your symptoms is that they will usually have a greater breadth of experience with respect to medical disabilities than any single patient is likely to have. This can mean that they have seen other individuals go through similar processes, and it may also mean that they are in a position to suggest possible workplace accommodations that could make returning to work feasible.
Discussing your symptoms with a trusted physician and comparing the limitations you experience in your daily activities to any medical restrictions, can make it easier to see whether there are any realistic options for “reasonable” workplace accommodations you might be able to request from your employer under the Americans with Disabilities Act (ADA) that could allow you to return to work.
Even if there is no set of accommodations that will make it practical for you to return to your former job, developing clarity around whether there are any workplaces circumstances under which you would be able to work full-time or part-time with your disability, and what those circumstances would be, is often helpful.
Review Policy Terms for Eligibility
Often, individuals considering how to apply for long-term disability insurance benefits will instinctively review their policies’ criteria for determining benefits eligibility with a view toward seeing for themselves whether their situation meets the policy requirements. Checking to make sure that you do not waste time and energy going through the LTD claim filing process for an application that will be automatically denied because your condition clearly falls outside the policy’s stated parameters can indeed be a wise precaution and an important step.
However, in other respects individuals considering whether and how to apply for long-term disability may be well-served to think of a policy’s listed criteria for benefits eligibility less as a tool for evaluating their own claims and more as a list of items they will need to prove to the insurance adjuster reviewing their applications. The specifics will depend on the exact terms of each policy, but there are a few areas most policies address that may be worth a close look as you get ready to file your claim.
Excluded Conditions
Sometimes, if a disability is caused solely by a diagnosed condition that is clearly excluded from coverage under the terms of the long-term disability insurance policy, there is not much the disabled person can do to affect the outcome of a claim. Exclusions for mental illness and substance use issues are especially common, but theoretically any condition may be excluded from coverage as long as the exclusion is clearly stated in the terms of the policy and complies with applicable laws regulating the insurance industry in the relevant state.
In other situations, an individual’s disability may be caused by the cumulative effects of co-existing conditions. Medical diagnoses that occur in a single patient but do not share a causal relationship are known as comorbid conditions, and some LTD policies may make eligibility determinations differently when the disability is the result of combined symptoms from two or more comorbid disorders than when a single diagnosis is implicated.
If you are disabled due to a combination of factors in which an excluded condition aggravates another condition that is not excluded, it may be worthwhile to review your long-term disability policy’s language on exclusions with the assistance of a disability lawyer. Depending on how the policy is written, you may also need to have another round of conversations with your healthcare team to try and establish the extent to which your disability is caused by factors other than the excluded condition.
Definition of Disability
Each long-term disability insurance policy will specify its own definition of disability. You will need to structure your documentation to show that your condition fits the eligibility criteria set out under the terms of the policy. Keep in mind that any restrictions based on excluded conditions, pre-existing conditions, or limitation of benefits for specific conditions can be expected to apply regardless of how the policy defines disability overall.
Policy Riders and Supplements
In some fields it is relatively common for individuals whose chosen work areas require a high degree of specialized skill and training to purchase policy supplements or “riders” to enhance their LTD coverage, even if the base plan is provided by an employer as part of the employee benefits package. This scenario tends to be especially common among individuals who have a strong expectation that their personal long-term employability and earning potential depend heavily on continuing to do the same kind of work they are already engaged in, not just continuing to work in the same general field or industry.
These supplementary forms of coverage can affect how your base policy’s definition of disability applies. Therefore, if you have purchased any additional coverage, you will likely want to review the terms and conditions in the relevant policy documents as well, and consider how they may impact your total benefits eligibility.
Elimination Period and Other Time-Sensitive Factors
Long-term disability insurance policies generally specify what is known as an elimination period. This is a mandatory waiting period between when you become disabled and when you are eligible to receive benefits. Filing early may simply result in an automatic denial of your LTD claim, while delayed filing can complicate what is often an already tricky financial situation. In thinking about optimal strategies for how to apply for long-term disability insurance benefits, you will want to identify your policy’s elimination period and review policy requirements for proving when your disability began. If you are transitioning from short-term disability to long-term disability, you may be able to use some of the documentation collected to support your short-term disability (STD) claim as part of your medical evidence to show a disability start date.
You will also want to take note of any deadlines associated with the LTD claim filing process. Outline your responsibilities for collecting and submitting documentation under a step-by-step LTD application guide, and schedule each task in your process to ensure that you meet the target dates set by policy deadlines. Whenever possible, aim to allow yourself a few extra days to weeks in case any problems arise during the submission process.
Collecting Medical Evidence
The type of medical evidence you may need to support your long-term disability claim will depend on the terms of your policy and the nature of your disability. In most cases, at a minimum you can expect that you will need to request a statement from the medical professional who has had primary responsibility for overseeing your care. You will also likely need to send copies of records indicating the factors that led to your diagnosis. For conditions such as back pain or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), whose symptoms may range in severity and are in many cases not visible to the naked eye, you may also need to submit records from your patient history documenting the progression and severity of symptoms in your personal case.
Submitting Your Claim for Benefits With Supporting Documentation
Once you have gathered medical evidence to show point-by-point how your condition meets each of the criteria for benefits eligibility required by your policy, review the policy terms on how to apply for long-term disability insurance benefits one more time, and submit all of your documents using whatever protocol your insurance company specifies. Be sure to retain a copy of all communications and each document sent for your own records. You may also wish to follow up with a representative of the insurance company to confirm that they have received your claim submission and that they have all of the information they need to begin processing your claim.
Be Prepared for a Denial
Obviously, individuals starting the LTD claim process hope that their applications will be approved as soon as possible. Following a step-by-step LTD application guide can help by making it easier to ensure that you have met all of the insurance company’s specifications for how to apply for long-term disability insurance benefits, but it is not a guarantee. Be prepared for the possibility that you may receive an initial denial, and familiarize yourself with the process for filing an appeal in case the insurance provider’s response is not what you would have wanted.
Navigating The Long-Term Disability Process
Navigating the long-term disability claim process can be overwhelming, but following a clear, step-by-step LTD guide can make a significant difference. By thoroughly understanding your policy, consulting with your healthcare team, and collecting strong documentation, you can increase the likelihood of a successful claim. Even if your application is denied, knowing the steps to take next can help you stay focused and prepared for an appeal. If you have questions or run into challenges, you do not have to face them alone. Consider visiting with experienced disability attorneys to guide you through every stage of the LTD claim process and to ensure your legal and financial rights are protected.
