At Bryant Legal Group, we get a lot of phone calls from people who need to file a long-term disability (LTD) insurance claim and don’t know where to begin. These people come from all walks of life, from blue collar workers to high-income professionals like doctors, lawyers, business leaders, and entrepreneurs.
Many of these professionals are struggling with their decisions to file. They’ve invested a lot of time and effort into developing professional skills and building businesses, only to find their health is suddenly making their life’s work impossible.
In this article, our experienced lawyers explain how to apply for disability insurance, challenges you might face in applying, and what to do if your claim is denied.
While some of this advice is tailored toward high-income professionals, most of it should apply to anyone considering a long-term disability claim. Keep reading to learn more about the application process, disability laws that may impact your claim, and ways you can improve your chances of getting approved.
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Do I Qualify for Long-Term Disability?
Generally speaking, you are eligible for long-term disability benefits if you can prove the following elements:
- You have disabling medical conditions, illnesses, or injuries
- Due to your health, you cannot perform your current job or potentially any other occupation, depending on the insurance company’s definition of disability in your plan (see paragraph below), or you are working but have suffered a loss of earnings due to the impact of your medical condition on your ability to do your work.
- You’ve completed a waiting period (sometimes called an elimination period)
Long-term disability coverage typically defines disability as either “own occupation” or “any occupation.” As you might expect, “own occupation” coverage applies if your disability prevents you from fulfilling the requirements of your current profession. But to be disabled under an “any occupation” plan, you must be unable to perform any job to which you might be reasonably suited. For this reason, we strongly recommend professionals in high-skill or high-paying careers purchase an own occupation policy whenever possible.
If you meet these requirements and have evidence, like medical records, to support your claim, you should receive a monthly benefit payment from the insurance company.
In theory.
However, in practice, insurance companies deny more disability insurance claims than they approve. A variety of factors can impact the strength of your claim, including:
- The severity of your medical conditions
- The strength of your medical evidence
- Your LTD policy’s language, especially its exclusions and limitations
- Whether you have a disability insurance lawyer advising you or if you are unrepresented
Long-term disability policies are purchased from for-profit insurance companies. When either you or your employer purchased long-term disability coverage, you agreed to specific terms and conditions. These terms can vary from policy to policy. To understand your LTD plan’s precise terms, review your insurance policy, Plan Document, or Summary Plan Description (SPD). A disability insurance lawyer can also help you translate and interpret these documents.
What Does the LTD Application Process Look Like?
The application process for long-term disability benefits may be a bit different for each person, depending on the insurance company and whether you purchased insurance through your employer or independently. But broadly speaking, these are the basic steps:
Speak With a Long-Term Disability Attorney
You are not required to use an attorney to file a long-term disability claim. If you wish, you may attempt to do so on your own.
However, there are significant risks to going it alone—particularly if your insurance coverage is provided through an employer. In this case, your coverage is likely governed by the Employee Retirement Income Security Act of 1974 (ERISA).
ERISA claims have strict requirements that limit a claimant’s legal options, including when (or if) they can file a lawsuit and when (or if) they’re able to supply new medical evidence for review. If your initial claim is denied, you will have to go through at least one administrative appeal with the LTD insurance provider before you can sue. And if you don’t include the necessary evidence to prove your disability in that appeal, you won’t get another chance to add to your case file—even if you go to court. If your claim isn’t handled with skill and care, you could end up permanently losing out on the benefits you deserve.
The best time to speak with a long-term disability lawyer is before you file your initial application. However, if you’ve already filed, it’s extremely important to contact a lawyer as soon as possible if your benefits are denied.
Carefully Review Your Plan Documents
Your plan documents will contain critical information about matters such as your insurance policy’s definition of disability, specific exclusions (such as for pre-existing conditions or those with self-reported symptoms), time limits for filing employee statements or appeals, when you can start receiving benefits (i.e., the exclusion period), and much more.
You’ll want to have a firm grasp on these details before you file a claim and reference them later when necessary. Even if you’re already working with an attorney, being familiar with the details of your plan documents can give you peace of mind and help you ask better questions.
Notify Your Employer
This, of course, only applies if you have employer-provided insurance. If you’re insuring yourself directly (for example, as a self-employed professional or business owner) you’ll need to contact your insurance company directly.
To formally begin the process of applying for long-term disability benefits, you’ll need to inform your employer you’ll be unable to return to work and intend to file for long-term disability benefits. Someone at your employer’s human resources department should be able to provide you with the application paperwork and instructions. You’ll typically need to provide information about your medical treatment, work experience, education, and daily activities, along with any other information that supports your claim.
Your employer will also need to provide an employer statement, which provides basic information confirming your name, job description, salary information, and when your last day of work occurred.
The Insurance Company Investigation Begins
Once you file your claim forms, the insurance company will assign your long-term disability claim to an adjuster, who will assess your eligibility for benefits.
During their investigation, the adjuster may ask you for more information or require you to undergo a functional capacity evaluation (FCE) or independent medical examination (IME) with one of their preferred physicians. They may even ask to meet with you in person to discuss your claim. If any of these situations occur, your long-term disability attorney can help prepare you.
Gather Supporting Evidence
Don’t rely on the insurance company to do all the work of uncovering necessary facts and medical records. They are incentivized to deny claims. They do not have your best interests at heart.
You should include as much relevant evidence supporting your claim as possible that supports a disability determination. This means more than just proving a medical diagnosis; you need to show that your specific condition and symptoms meet your policy’s definition of disability.
Please note that the rules for when you can submit evidence vary drastically depending on whether you purchased your long-term disability plan independently or if it’s provided by an employer. If you have an individual plan, you can submit new evidence at any stage of your claim—even at a trial. But if you have an employer-provided plan (i.e., one governed by ERISA), you will only have a limited time to submit evidence. Anything not already in your claim file during the administrative appeal process cannot be used, even if you later file a lawsuit and take the insurance company to court.
Evidence might include:
- Medical records and test results
- Your physician’s opinion
- Opinions and statements from other relevant experts, such as members of your medical team, vocational experts, etc.
- A detailed description of your job duties (and why your symptoms make them impossible to perform)
- A daily journal of symptoms and how they affect your life
- Witness testimony from friends and family
- A short letter summarizing the evidence in your claim file and your argument for why your claim should be approved.
- Financial documentation showing your loss of earnings, if you are filing for residual disability benefits or partial disability
- RELATED POST: How Do You Prove You Are Disabled? – Bryant Legal Group (bryantlg.com)
Eventually, the adjuster will either approve or deny your claim. If it’s approved, you should start receiving your monthly benefit check. If the insurance company denies your long-term disability claim, you can explore your appeal options.
Common Questions, Issues, and Concerns
When Should I Apply for Long-Term Disability?
We encourage you to consult your doctors and a skilled disability lawyer as you make decisions about your disability insurance application. Your decision to apply for disability benefits should be grounded in your prognosis and a comprehensive legal strategy.
If your medical providers are encouraging you to file for disability or your short-term disability benefits are about to run out, it’s a good time to start the long-term disability application process.
If you have already started to suffer a loss of earnings due to your medical condition’s interference with your ability to do your job, or you anticipate that your employer may take some adverse employment action against you (demotion, employment termination) due to the decline in your performance, we recommend seeking counsel with an experienced disability insurance attorney immediately.
How Much Will I Get in Long-Term Disability Benefits?
Your monthly benefit will vary depending on the specific terms and conditions of your long-term disability policy. While most LTD plans pay between 50% and 80% of your monthly earnings, plans typically have maximum benefit caps (often between $10,000 and $20,000 per month).
Things might get trickier for professionals who have variable earnings—for example, independent contractors, small business owners, or workers who are paid a variable bonus or commission on top of a base salary. Different policies will handle this differently. If you have a highly variable annual income, you should ideally look for private disability insurance policies that consider supplemental income and/or calculate your average earnings over a longer timeframe.
In some cases, the insurance company may attempt to settle your long-term disability claim with a lump sum buyout. This is a huge decision to make, with several potential pros and cons for disabled professionals. Working with an attorney to evaluate your options is strongly encouraged, since once you settle you will not be able to go back and alter the terms of the payout or go back to receiving monthly benefits.
The Insurance Company Scheduled Me for an IME. What Does That Mean?
During an “independent” medical examination (IME), a physician will examine you and provide the insurance company with a report that outlines their diagnoses, recommended restrictions, and records other information. Unfortunately, these examinations are rarely neutral or independent. Insurance adjusters pay a significant fee for IMEs, so they want to get the most out of their investment. Insurers often use IME doctors who consistently support insurance companies’ interests by minimizing claimants’ conditions and limitations.
If you’re scheduled for an independent medical exam, it’s a sign the insurance company may be preparing for a fight. Before you attend the evaluation, you should consult a disability insurance lawyer who can help you prepare for the appointment and guide you through your legal claims.
Will I Also Have to Apply for Social Security Disability?
Many long-term disability policies require that you apply for Social Security Disability Insurance benefits. Most insurance companies typically offset your monthly LTD benefit by any SSDI benefits you receive. If you refuse to file a Social Security application, your LTD carrier may terminate your monthly benefit payments.
Social Security disability is an entirely different process than long-term disability. You’ll need to convince the federal government that you are totally disabled and cannot perform any type of work, including the simplest, lightest jobs. This definition of disability may be very different than your LTD’s policy terms, especially if you have a liberal “own occupation” plan.
If you have questions about how a Social Security claim may impact your long-term disability benefits, please contact Bryant Legal Group. We can answer your questions; however, we do not handle standalone Social Security disability claims. Our focus is on employer-sponsored and privately funded disability insurance policies.
Supplemental Disability Insurance Can Help High Wage Earners Fill an Income Gap
If you have a high income, maximum monthly benefit caps can lead to a significant income gap when you’re disabled.
For example, suppose you’re an anesthesiologist who earns $400,000 per year. Your LTD policy might pay out 75% of your monthly income, but the policy also has a $15,000 maximum monthly benefit. Without the maximum monthly benefit cap, you’d receive $300,000 in annual LTD benefits ($400,000 x 0.75 = $300,000). But, due to the cap, you’ll only get $180,000 ($15,000 x 12 = $180,000).
For many professionals, that lost income would be catastrophic. That’s why people add supplemental long-term disability insurance policies to their employer-sponsored plans. If you have multiple long-term disability insurance policies, you’ll need to file separate claims with each one. While this may seem burdensome, it can provide you and your family with much-needed financial support, and a lawyer can help you streamline the process.
The Adjuster Denied My LTD Claim. Now What?
As we mentioned above, insurance companies deny a large proportion of long-term disability claims, including many legitimate ones. If the adjuster denies your LTD application, you need to act quickly and decisively.
Depending on your policy, either state or federal law may apply to your appeal, and each system has its own procedures and rules. Under ERISA (Employee Retirement Income Security Act of 1974), federal claims involve relatively short filing deadlines and a two-step appeal process.
Bryant Legal Group: Fighting for People With Disabilities in Illinois
As one of Illinois’ premier disability insurance practices, Bryant Legal Group has helped many professionals get the long-term benefits they deserve. We take a proactive approach to LTD claims, helping doctors, lawyers, and others from the very beginning of the process. Using this approach, you can potentially avoid simple mistakes that could cost you your benefits. And, if the insurance company denies your claim, you’ll already have a trusted partner at your side who can file an appeal.
To schedule your free, no-risk consultation with an attorney from the Bryant Legal Group team, contact us at (312) 561-3010 or complete our online form.
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.