To qualify for long term disability insurance benefits, you must prove you have a severe, medically determinable impairment that limits your functioning to such an extent that you aren’t able to work in your own occupation, or any occupation, depending on how your insurance policy defines the term “disability”. An insurance adjuster analyzes each disability claim for the insurance company.
The Basics of Medical Eligibility for Disability Benefits
Long Term Disability insurance pays monthly benefits to insured employees who become unable to perform the duties of their job for medical reasons.
There are several ways you can prove your injury or sickness qualifies as a disability.
Some applicants continue to receive disability benefits even after their medical condition improves.
You don’t have to be disabled for any length of time before you apply for long term disability benefits, but there is typically a 90 to 180 day waiting period to receive LTD payments.
Factors That Can Affect Disability Eligibility
Most people understand that medical evidence is essential in a long term disability claim, but sometimes the importance of the treating physician(s) is overlooked.
A treating physician is a medical doctor who provides medical treatment for you and has, or has had in the past, an ongoing relationship with you. There needs to be a history of treatment between the medical provider and the patient for the medical provider to be considered a treating physician
An important factor in your claim for long term disability insurance benefits is your credibility. This is especially true if part of the reason you can’t work is due to pain or if you suffer from a mental illness because these conditions are difficult to measure with objective medical tests (like blood tests, X-Rays or MRIs.)
If you’re filing for disability benefits and don’t seek treatment for your impairment or don’t follow your doctor’s orders, your credibility will be in question.
The insurance company must take your pain into account as long as you’ve been diagnosed with a physical or mental impairment, including fibromyalgia.
If you have a physical impairment that could be improved by surgery but you refuse to have the operation, you may be barred from receiving LTD benefits. Your insurance policy likely has a specific clause relating to this issue.
Tips on Medical Eligibility From Disability Lawyers
Your physical RFC will determine whether you can perform sedentary, light, medium or heavy-duty work.
Your mental RFC will determine whether you can perform work-related mental activities.
The Long Term Disability Benefits process is frustrating for most people. You have to fill out numerous forms, talk to numerous people about your disability, and more. This guide helps you avoid ten common pitfalls in disability insurance claims.