If you know that you have long-term disability benefits as part of your insurance policy, you might think that getting those benefits is as simple as completing an application. Unfortunately, as part of an experienced long-term disability law firm, I can tell you that is decidedly not the case for long-term disability policy benefits.
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There are specific terms that you have to meet in order to qualify, and those terms differ depending on the policy itself. However, there are a number of provisions that are typical to most long term disability policies. Today, we’re going to cover one of those provisions – meeting your insurer’s definition of disability.
You’ll Only Receive Long Term Disability if You Meet the Included Definition
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If you look through your policy, you will see a definition for Disability or Total Disability. Frequently, these are broken into two parts – the first describing disability as an illness or injury that keeps you from doing your own occupation, and the second part saying that this same condition doesn’t allow you to work in any occupation. Generally speaking, the second part doesn’t really come into play until after 24 months. Someone suffering from the same ongoing disability that is preventing them from obtaining gainful employment should qualify for this second part, which is essentially just saying that you’re not able to work at all, regardless of the job.
Pay careful attention to the words used in this definition. Often your insurer will provide definitions for those, too, and you have to meet every part of the definition to qualify. Some common ones to watch out for include:
Own occupation. This refers to the job that you currently hold or held before your disability interfered. If you’re an accountant, you have to be able to show that your condition prevents you from doing that kind of work to meet the “own occupation” clause.
Any occupation. The word “any” tends to throw people off here, because it doesn’t literally mean that your disability keeps you from doing anything at all. Under most definitions, it means that you can’t do any job for which you have training and experience. A trained long term disability lawyer, for example, probably has experience that would allow them to work in a number of other fields, but a construction worker’s experience could limit them to physical labor.
Injury or illness. Many insurers refuse to pay disability if the injury you’re suffering from was self-inflicted or your illness involves drugs or alcohol. And these are only two of the most common conditions excluded. Look carefully at your policy to make sure your disability is covered.
Next time, we’ll talk about another provision you need to meet to quality for long term disability in ERISA plans – the elimination period.
If you’d like to learn more about long term disability in general, check out our free resources!
