Whether you are applying for disability for the first time or have been previously denied, you are not alone. However, it can certainly feel that way trying to complete a long term disability (LTD) application while struggling with pain, injury, or illness. Previously unsuccessful LTD applications do not necessarily reflect how sick or injured you are, nor do denials mean that future applications won’t be approved. Many applicants successfully meet long term disability requirements after submitting follow-up applications with the help of a doctor specializing in their medical condition and a lawyer experienced in navigating the LTD system.
What Is Long Term Disability?
Long term disability coverage provides financial compensation to individuals who become “totally disabled” for an extended period. A person might be considered totally disabled if they are unable to perform work duties on their own accord following an accident or illness. You do not have to be permanently disabled to qualify for LTD benefits.
LTD is provided by many employers through disability insurance plans that cover workers if they cannot work due to a medical condition. BC residents may also choose to pay for their own LTD coverage through a private provider. Depending on the plan, beneficiaries may receive anywhere from 60% to 80% of their regular rate of pay while disabled.
Long Term Disability Requirements
LTD requirements include eligibility criteria based on your current job responsibilities, your vocational history, the details of your benefits plan, your medical history including the injury or illness affecting work, and your future medical prognosis.
To determine eligibility, insurance companies will assess your medical condition and how it prevents you from completing the duties of your job. They’ll also consider how your condition is expected to improve over time and whether reasonable accommodations can be made by your employer to keep you on the job.
Employment Status
As mentioned, LTD is often an employer-based benefit. If you do pay into LTD benefits through an employer, you must be an active regular employee when you become disabled to qualify for those benefits. Most plans also have a waiting period, called an elimination or qualifying period, before benefits become active. This period usually ranges between three and six months, depending on the plan.
If you pay for an LTD plan on your own, your terms may be different. However, it’s likely private plans also include a clause stipulating that you must be earning income or employed at the time of disability to earn benefits.
Medical Condition and History
A medical evaluation will help determine the extent of your injury, illness, or condition and whether it qualifies you for disability benefits. Qualifying conditions can include physical and mental disabilities. Some receive benefits due to an acute illness or accident, while others may suffer from a worsening chronic condition that has become unmanageable. What matters most is how severe your condition is, how much it limits your capacity to work, and if your circumstances meet individual policy guidelines.
Some broad long term disability examples include:
Autoimmune diseases
Cancers
Cardiovascular conditions
Chronic fatigue or pain syndromes
Digestive disorders
Hearing or vision impairment
Mental health conditions
Musculoskeletal disorders
Neurological disorders
Respiratory disorders
For a more specific example, say that you injured your back in a slip and fall accident. Just because your back hurts doesn’t mean you will be granted LTD benefits. You must prove your injury hinders your ability to perform your job for an extended period of time and that potential accommodations would fail to aid you in completing your duties as intended.
Disability History
Most LTD applicants will have previously applied for short term disability or EI sickness benefits, especially during the elimination or qualifying period mentioned above. In some cases, successful short term disability or EI benefit applications can support your long term disability application. Consider that:
- Receiving short term disability benefits does not automatically make you eligible for LTD
- A wrongfully denied short term disability application does not disqualify you from receiving LTD benefits
- Your short term disability and your long term disability doctor may not be the same
Insurance companies will almost certainly mandate that you regularly see an appropriate healthcare provider for your disability so that you receive ongoing care and treatment with the intent to improve your condition. It’s possible your insurance companies may even request that you see a specialist for your condition and use it as an excuse not to award benefits. Ask your personal doctor about being referred to a specialist. You might explain to them that you are applying for LTD and need help with your application. They can help point you to a doctor specializing in your injury or illness.
Policy Details
Most insurance plans distinguish between “any occupation” and “own occupation” benefits. Your policy makes one or the other available to you and, in some cases, plans include both. These designations refer to the circumstances under which you’ll be considered eligible for benefits and what it means to be “totally disabled” and unable to work. Plans may use the “own occupation” standard for the first two years and switch to the “any occupation” standard after that time.
“Own occupation” policies consider whether your condition prevents you from working at your preferred job. For example, a surgeon with an own occupation policy who develops multiple sclerosis and experiences tremors that prevent them from performing surgeries would likely receive benefits. Even if they could take a less physically demanding job, such as teaching or consulting, the policy still considers them disabled from their specific profession.
“Any occupation” insurance only provides coverage if your disability prevents you from meeting the responsibilities of any job due to injury or illness, regardless of your employment history. The standards of any occupation policies are often more difficult to meet because the person’s disability must affect a broader range of vocations. Some occupation-based insurance plans may still consider your employment history if the only jobs available represent a significant loss of income or responsibilities that depart significantly from previous work experience.
Both types of coverage provide similar payout even though the circumstances in which one is eligible are different. Each type of plan pays a percentage of your previous income, usually 60 to 80% of regular pay.
When to Speak With a Lawyer
Unfortunately, far too many BC residents with valid LTD claims will face denials. Whether you are trying to submit your initial claim or need help with an LTD appeal, Stephens & Holman will be there for you. Reach out to our office today to schedule your free consultation.