Medical Conditions That Qualify For Long-Term Disability

Last Updated: November 13, 2024 // Reviewed and Edited by: Ortiz Law Firm

When faced with a disabling medical condition, discovering whether it meets the requirements for long-term disability benefits is a vital step in the process. Knowing the specific criteria for eligible conditions can help individuals assess their options and take necessary steps to secure financial support.

If you have received a long-term disability claim denial, we may be able to help you file an appeal or lawsuit to recover your benefits. Since 2012, the legal team at Ortiz Law Firm has been committed to assisting individuals denied the long-term disability benefits they deserve. We can manage the legal intricacies, enabling you to concentrate on your well-being and family while we fight to obtain the benefits you deserve—call (888) 321-8131 for a free case review.

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Understanding Long-Term Disability Insurance

Long-term disability (LTD) insurance offers financial assistance to employees who can’t work for an extended time due to health issues, injuries, or accidents. This form of insurance allows employees to receive a percentage of their usual income while unable to perform their job duties, regardless of where the injury or illness occurred. Regrettably, some insurance providers might unjustly deny your LTD claim to increase their profitability.

Eligibility Criteria for Long-Term Disability Benefits

In broad terms, you could be eligible for LTD benefits if you:

• Obtain long-term disability insurance coverage.
• Have a qualifying medical condition and
• Submit an LTD claim to your insurance carrier.

Medical Conditions That May Qualify for Long-Term Disability

A wide array of medical conditions may qualify for long-term disability. These conditions and the necessary medical treatment can significantly interfere with an individual’s ability to obtain and maintain gainful employment, thereby making such individuals eligible for disability insurance benefits.

However, you must understand your insurance company’s definition of disability before submitting a claim. You can find this information in your insurance policy. It’s important for applicants to carefully review their policy’s terms and conditions to see if their specific medical condition is excluded from coverage or if benefits may be limited.

For more information about the medical criteria for long-term disability benefits and how we can assist you in appealing a denied claim, don’t hesitate to contact us—call (888) 321-8131 for a free case review.

Categories of Medical Conditions for Disability

Cancer

Oncological disorders like cancer are among the leading causes of LTD claims. Patients dealing with cancer frequently undergo therapies such as chemotherapy and radiation, resulting in side effects that may impair their ability to work for a prolonged duration. During this challenging time, disability insurance can provide essential financial assistance. Many types of cancer may qualify you for benefits, including:

Cardiovascular Disorders

LTD insurance plans typically cover heart failure, ischemic heart disease, and cardiac arrhythmias if these issues significantly restrict one’s physical capabilities and performance at work.

Insurers may periodically reevaluate heart-related claims by requesting updated medical evidence several months after a cardiac event to reassess your ability to work. Common cardiovascular disorders include:

Chronic Illnesses

A chronic illness is a condition that persists and necessitates continuous medical treatment over time.  Some conditions that are often chronic and may qualify for LTD benefits include:

We helped a client with chronic fatigue after Reliance Standard terminated the claim, citing a policy provision that limits payment of benefits for a disability caused by or contributed to by a mental or nervous disorder to 24 months. We appealed the denial, and the claim was reinstated!

Congenital Disorders Affecting Multiple Body Systems

Mosaic Down syndrome is the primary congenital disorder that may qualify for LTD benefits. Other inherited conditions that affect multiple systems within the body may also be considered eligible if they result in significant functional limitations and restrict routine activities. These conditions include:

Degenerative Diseases

A degenerative condition is a disease where an organ’s cellular and tissue makeup progressively decline. Examples of such conditions include:

• Huntington’s Disease
• Parkinson’s Disease
• Amyotrophic Lateral Sclerosis (ALS)

Endocrine, Metabolic, and Nutritional Disorders

Conditions that disrupt hormonal balance, like diabetes, thyroid issues, and elevated blood sugar, may qualify for LTD benefits.

Gastrointestinal Disorders

Digestive system disorders such as Crohn’s or liver disease can lead to incapacitating symptoms that may affect one’s ability to perform regular work duties.

Insurers generally assess how treatments influence the intensity and persistence of gastrointestinal conditions before confirming if a claimant is eligible for LTD benefits. Some digestive disorders include:

“I was fighting a long-term disability company whose policy I had bought and who refused to pay any of my benefits after I became disabled. Nick agreed to take my case and though there were many hoops he had to jump through, he never gave up. I will always be grateful to Nick and his staff for all the work they did on my behalf.” – Teacher in North Carolina with a Denied Disability Claim

Genitourinary Disorders

Under LTD plans, conditions affecting the kidney and urinary system that result in chronic kidney disease or complete renal failure may also be covered. Insurers consider related symptoms, complications, and related conditions when evaluating claims. Genitourinary impairments could include:

Hematological Disorders

Some blood-related conditions, such as severe anemia or clotting issues, could be covered if they significantly limit your ability to work.

Factors such as your symptoms, the effectiveness of your treatment, and medication side effects will be considered by your insurer when assessing your claim. Some hematological disorders that may qualify for long-term disability benefits include:

Immune System Disorders and Infections

LTD insurance might cover issues related to the immune system, often characterized as ​​autoimmune disorders, immune deficiency disorders (excluding HIV), and HIV infection. These conditions can result in considerable physical limitations for the insured. Common autoimmune disorders include:

Mental Disorders

Various psychiatric conditions, including clinical depression, bipolar disorders, and schizophrenia, might be covered under LTD insurance. Insurers will thoroughly review your medical history and daily functions to ascertain eligibility. In extreme cases, these disorders may compromise one’s ability to hold a regular job. Several mental health conditions could qualify for long-term disability benefits, including:

Although these illnesses are severe, you must verify the existence of your illness and the resulting limitations. Proving the existence of your illness and the resulting limitations can be challenging. Policyholders should also be aware that many policies limit the benefit period for mental health claims.

Most LTD policies have a maximum benefit period of 24 months for mental health conditions. The insurance company uses the reasoning that these illnesses are difficult to prove with medical testing and lab reports so that they can be faked or exaggerated. Request a free case review to see if a long-term disability lawyer at Ortiz Law Firm can help you pursue additional benefits beyond your policy’s mental health limitation.

Musculoskeletal Disorders

According to the Council for Disability Awareness, musculoskeletal conditions are the most common reason for filing LTD claims. These claims can include ongoing back pain, various forms of arthritis, and joint issues, resulting in persistent pain and physical limitations, making it difficult for people to carry out their usual job responsibilities.

Musculoskeletal impairments include:

Neurological Disorders

LTD policies often cover nervous system conditions like epilepsy and Parkinson’s disease, which can lead to considerable functional limitations.

Reviewers will examine how your condition affects your physical and cognitive abilities and impedes your regular work activities. Some of the neurological disorders that may result in impairment include:

Respiratory Disorders

Conditions like COPD or severe asthma could qualify for LTD benefits. These respiratory issues can impair breathing and limit one’s ability to undertake physically demanding tasks. Respiratory disorders that may result in a disabling impairment include:

Skin Disorders

LTD benefits may be an option for those unable to maintain consistent employment due to acute and debilitating skin conditions. Factors like the size, location, and frequency of outbreaks are assessed. Common skin disorders include:

Special Senses and Speech Impairments

Severe impairments affecting vision, hearing, or speech may also be eligible for LTD benefits. Such impairments can significantly affect one’s capacity to communicate and perform effectively in a work setting, making them eligible for disability benefits. These conditions may include:

Other Requirements for a Long-Term Disability Insurance Claim

Each policy has a specific definition of disability and other requirements that must be met for a condition to qualify for benefits. You should review the terms of your particular policy when determining whether your medical condition will be eligible.

Although the specific terms may differ, every claimant must meet several medical and non-medical requirements to receive long-term disability insurance benefits.

Have Long-Term Disability Insurance Coverage

The first requirement for filing a long-term disability insurance claim is that the individual must have long-term disability coverage. This means that the individual must have a long-term disability insurance policy in place that provides coverage for the type of disability that they are experiencing.

Typically, individuals obtain long-term disability insurance coverage through their employer or by purchasing a policy directly from an insurance company.

Meet the Minimum Work Hours Requirement

Generally, most LTD policies require you to work full-time (35 hours or more, or as otherwise defined in your policy) per week over some time. The exact working-hour requirements will be outlined in your policy. Be sure that you have worked this minimum amount before applying for benefits.

Meet the Definition of Disability

The next requirement for filing a long-term disability insurance claim is that the individual must meet the definition of disability outlined in their insurance policy. Claimants must provide medical documentation to support their claim of disability, which should include information about the nature of the condition, the treatment plan, and how the condition prevents them from working.

The definition of disability can vary depending on the policy, but generally, it requires that the individual be unable to perform the material and substantial duties of their occupation due to a medical condition for the first two years that benefits are payable, after which it changes to any occupation.

Satisfy the Elimination Period

You must continue to meet the definition of disability throughout the entirety of the elimination period. The elimination or waiting period is how long an individual must be disabled before benefits are paid out. The policy determines the length of the elimination period, which can range from 60 to 180 days or more. During the waiting period, the individual is responsible for covering their expenses.

The duration of the elimination period affects the policy’s cost, with longer elimination periods resulting in lower premiums.

Comply with Insurance Company Requirements

Finally, the individual must comply with all requirements set forth by the insurance company to receive long-term disability benefits. For example, appropriate care is often a requirement for receiving disability benefits. This means that a policyholder must receive medical treatment that is considered appropriate for their condition to receive disability benefits. Other requirements may include providing medical documentation, attending appointments, and complying with requests for information from the insurance company.

Filing a Claim for Long-Term Disability Insurance

When filing a claim for long-term disability, remember that insurance companies are vested in demonstrating that you don’t meet the criteria for receiving long-term disability benefits. Rest assured, they will request comprehensive information about your medical condition, including diagnostic tests, healthcare records, and any other pertinent documents.

Your insurance provider may even attempt to reject your long-term disability claim by inaccurately categorizing your condition or asserting that your condition is mental when it is a physical disease. Fortunately, if your claim for disability benefits is turned down, Ortiz Law Firm may be able to assist you in challenging the decision.

“Ortiz Law Firm has done an amazing job keeping me updated on every step of the process, which helped relieve some of my stress. It was also tremendously helpful to no longer have to personally deal with the anxiety created by the constant bombardment of arguments and requests from the insurance company.”
– Analytics Consultant in Iowa with a Denied Disability Claim

Challenging an Unjust Denial of Long-Term Disability Benefits

If you believe your disability claim was unjustly denied and you are eligible for benefits, don’t accept the denial without question. It’s possible to appeal the insurer’s ruling and receive the benefits you rightfully deserve.

You can appeal on your own, but you take the risk of overlooking important details or leaving out crucial information. There is no reason to take this risk when Ortiz Law Firm, a national disability law firm, stands ready to assist you.

Since 2012, Ortiz Law Firm has helped clients nationwide recover their denied disability benefits. We have represented claimants in claims with New York Life, Lincoln Financial/Liberty Life, Reliance Standard, Prudential, The Hartford, The Standard, MetLife, Guardian, Unum, Sun Life, and various other disability insurance companies.

We can help you fight back against an unjust denial. To receive a free, no-obligation case evaluation, complete our online contact form or dial (888) 321-8131 today. Our experienced legal team will listen to your story and inform you about your legal rights.

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