When you can't work because you're sick or injured, having long-term disability (LTD) insurance can ensure you continue to have income—but only if you meet the policy's long-term disability requirements. And you'll have to clear many other hurdles before benefits are approved.
The most important requirement for long-term disability is proving—with medical evidence—that you meet your insurance policy's definition of disability. But there are other requirements you must keep in mind when applying for long-term disability benefits, including the following:
Here's what you need to know about most insurance companies' long-term disability requirements and what you need to do to qualify for benefits.
Long-term disability insurance provides income when you can't work for several months or more because of an injury or illness. Your employer might provide long-term disability coverage as part of a benefits package, or you can purchase an individual policy. Either way, long-term disability insurance offers you an important financial safety net if you must stop working because of a disability.
If you have a group long-term disability policy through your employer, learn what you need to know about your rights under federal law.
If you're thinking about filing a long-term disability claim, the first thing you need to do is make sure you understand how your LTD policy works, including how the insurance company defines "disability." There are a couple of ways to get this information:
Don't skip this step. Understanding your policy's long-term disability requirements will tell you what you must do to qualify for LTD benefits.
Generally, your LTD company will find you "totally disabled" if you're unable, due to illness or injury, to substantially perform the duties of your occupation. But some long-term disability insurance companies define "disabled" as being unable to do any kind of work.
And you usually have to stop working before you can collect long-term disability benefits. With most insurance companies, you can't file a claim for long-term disability if you're still on your employer's payroll—even if your hours have been significantly reduced due to your medical condition.
If your long-term disability policy provides for "partial disability," you might qualify for LTD benefits if you can no longer work full-time in your regular occupation. Partial disability provisions will sometimes pay long-term disability benefits even if you can work full- or part-time at another job.
Getting a supporting opinion from your doctor is the most important factor in proving your long-term disability claim. As part of your application for LTD benefits, your doctor will be asked to complete a form or write a statement regarding your condition. That statement should explain how your limitations relate to your ability to work.
As critical as your physician's opinion is, the long-term disability claims administrator will also want objective proof of your condition. The administrator will need to see all the medical records related to your disability, including the following:
To show that your disability is ongoing, you should continue to receive treatment from your doctor while your long-term disability claim is pending and even after you're approved for benefits. Failure to continue treatment can be grounds for the insurance company to terminate your long-term disability benefits.
When you apply for LTD benefits, there are a number of other things you need to know about how long-term disability insurance works—including some precautions you need to take.
Most people insured under long-term disability plans have free (or very low-cost) coverage through their employer. If you're required to pay premiums for your long-term disability coverage, failure to make those payments on time could cause your insurance to lapse. If that happens, you'll lose your long-term disability coverage.
Most employer-sponsored long-term disability plans require that you're a full-time employee at the time you become disabled to qualify for benefits. "Full-time" is usually defined as working at least 30 or 35 hours a week, but check your long-term disability policy to be sure.
Virtually all long-term disability policies have an "elimination period" before you can begin receiving benefits. During this waiting period, you're not yet eligible to collect long-term disability benefits.
Waiting periods are often three months or six months. But if you have a short-term disability (STD) policy through the same insurance company, it's common for the long-term disability waiting period to last until your STD benefits expire (usually after six months).
Note that you'll likely be required to use up all your sick leave before filing for short-term disability and then exhaust all short-term disability before filing for long-term disability.
Many long-term disability policies have exclusions for pre-existing conditions. A pre-existing condition is generally classified as an illness or injury that was diagnosed or treated within a certain period (often 90 or 180 days) before your long-term disability coverage began.
If you have such a condition, you won't be able to get LTD benefits for any long-term disability that arises from that pre-existing condition—usually for the first twelve months that you have long-term disability insurance coverage.
Before filing a long-term disability claim, make sure that your LTD policy covers your illness or injury. Some long-term disability policies have exclusions for particular diseases or workplace accidents.
For most physical impairments, long term disability can last until you reach retirement age (age 65 or 66, for many policies)—assuming you remain disabled that long. And if you don't become disabled until you're 60 years old, you may be able to get LTD benefits until you're 70 or older.
But many long-term disability policies will only pay benefits for up to 24 months for certain disabilities, including the following:
LTD companies can also stop your benefits in some situations. Here are some examples:
For more information, read our article on when long term disability benefits run out.
If you've been approved for long-term disability benefits, almost all policies require you to apply for Social Security disability insurance (SSDI) benefits as well. And if you're approved for SSDI, your insurance company can "offset" the amount you receive from Social Security against your monthly long-term disability payment—meaning your LTD benefits will be reduced based on how much SSDI you receive.
Because of this offset, your insurance company has a significant interest in seeing you approved for Social Security disability. So your long-term disability insurance company might even hire a disability attorney to represent you in your Social Security case.
Similarly, if you're receiving long-term disability benefits based on an injury that occurred on the job, you'll probably also be required to file for workers' compensation. Like Social Security disability payments, any workers' comp you receive will offset your long-term disability benefits.
It's important that you follow through on your Social Security disability and workers' compensation claims. Ignoring these long-term disability requirements can result in losing your LTD benefits.
Updated February 10, 2023