What Conditions Qualify for Long Term Disability?
Many conditions qualify for long-term disability benefits, but obtaining these benefits is not always a straightforward endeavour. Those seriously injured in accidents may receive long-term disability, but so may people with a variety of chronic diseases. Overall, if the injury or illness prevents you from working at your job, you should qualify for long-term disability.
There is a caveat, however, as much depends on the type of disability policy carried by the employer. Some policies mandate that an employee cannot work at any type of job, not just in the position currently held. Many policies offer up to two to five years’ worth of long-term disability benefits if the person cannot work at their standard job, but if the person is still disabled at the end of that period, then he or she may only receive benefits if unable to work at all. Other plans may mandate that a disabled worker participate in a rehabilitation or job-training program if they are able to work again. Long-term disability is not synonymous with permanent disability.
Our personal injury law firm can review your employer’s disability insurance policy and aid you in filing the often-complicated claims forms.
Long-Term Disability Conditions
Conditions generally qualifying for long-term disability include:
- Bi-polar disorder
- Cancer
- Crohn’s disease
- HIV/AIDs
- Lupus
- Multiple sclerosis
- Traumatic brain injury
Issues affecting mobility often qualify for long-term disability, such as chronic back issues like degenerative disc disease. So do illnesses affecting the person’s ability to work, such as fibromyalgia or chronic fatigue syndrome, even though these diseases are not life-threatening.
Long-term disability is not necessarily related to any time spent in the hospital. While many conditions qualifying for disability do involve hospitalization, many others do not.
Completely or Totally Disabled
Specific policy language makes all the difference when determining whether a worker is eligible for long-term disability benefits. If the policy states that only “total” or “complete” disability is a qualifying condition, it does not necessarily mean the person is ineligible. It does mean that the individual cannot carry out the tasks required of his or her job. Recovery is dependent on not working until the condition has healed.
Documenting Disability
A doctor or similar licensed healthcare provider must document your condition, confirming not only the disability per se but that it meets the criteria set forth in the disability insurance policy, such as the inability to perform your specific job or any work whatsoever.
Expect your employer to want every detail regarding your medical condition, including:
- Lab test results
- X-rays
- MRIs or similar diagnostics
- All other medical records
Your employer’s insurance company may require you to submit to an examination by a physician of its choice to verify the determination made by your healthcare provider. While this is an accepted practice, the insurance company’s doctor is working on its behalf, not that of the patient. While it is vital to answer the doctor’s questions honestly, if you feel the insurer’s doctor is making unreasonable requests, speak to a lawyer about the issue.
Benefits Replacement
In most cases, long-term disability insurance replaces between 60 and 70 percent of the person’s employment income. However, most employees have already lost months of work before a long-term disability claim is approved, and benefits begin. Depending on the policy, this qualification period may last as long as six months.
Most employers also carry short-term disability coverage for workers, and you may often receive these benefits within a week or so while waiting for a decision regarding your long-term disability eligibility.
Insurance Company Tactics
Keep in mind that insurance companies may go to substantial lengths to attempt to disprove or minimize the validity of your disability claim. That may include hiring private investigators to follow patients and try to video or photograph them to show they are not as disabled as alleged.
Contact a Vancouver Long-Term Disability Lawyer
An experienced lawyer at the long-term disability law firm of Preszler Injury Law can evaluate your case and let you know your rights and options. Call us today or contact us online to arrange a complimentary consultation. Because there are strict deadlines involving disability compensation, it is crucial to obtain legal advice as soon as possible. We can also help with an appeal if your disability claim is denied. Because we work on a contingency basis, there is no fee unless we win your case.
