What to Know About Long-Term Disability Eligibility Criteria

Navigating the world of long-term disability (LTD) benefits can be overwhelming, especially when faced with a health condition that impedes your ability to work. Understanding what makes you eligible for your benefits is essential to receiving the benefits you deserve. Here’s a comprehensive look into what to know about long-term disability eligibility criteria and how to position oneself in the application process better.

1. Definition of Disability 

The primary factor in determining eligibility is how “disability” is defined in your policy or plan. Many plans define disability one way for a certain duration (often the first 12 – 24 months) and then change to a more stringent definition.

• Own Occupation: Under this definition, you’re considered disabled if you cannot perform the tasks of your specific occupation due to illness or injury.
• Any Occupation: A stricter definition considers you disabled only if you cannot work in any reasonably suitable job based on your training, education, and experience.

2. Waiting or Elimination Period

Before you start receiving LTD benefits, there’s typically a waiting period. This is the time between when your disability begins and when you start receiving benefits. It’s important to know what your duration is, as it can range from 30 to 180 days.

3. Medical Evidence 

Providing robust medical evidence is paramount, so regularly visit a doctor for your condition. The insurance company will look for consistent medical records detailing your disability.

Lab reports, X-rays, MRIs, and other diagnostic tests can bolster your claim. Ensure that all results are up-to-date and relevant to your condition, and that you treat as often as your doctors recommend.

4. Work History 

Your work history is pivotal, especially when determining if you qualify under the “Any Occupation” definition. An extensive work history in a specialized field might help you argue that you’re not suited for other types of work due to your disability.

5. Length and Terms of Coverage 

Your LTD policy will have specifications on:

• The Duration of Benefits: Some policies might pay out until you reach retirement age, while others might have a cap of 5-10 years.
• Exclusions: Certain conditions, especially pre-existing ones, might be excluded from coverage. Ensure you’re fully aware of any such stipulations.

6. Mental Health and Substance Abuse 

Many LTD policies treat mental health conditions and those stemming from substance abuse differently than physical ailments. There may be limits on the duration of benefits, typically 24 months. If your disability falls under this category, being aware of these limitations is important.

7. Filing within Deadlines 

LTD claims are time-sensitive. Missing a filing deadline can lead to a denied claim. Be vigilant about all required submission dates, from initial claim paperwork to any requested additional information.

Disability Benefits Assistance in San Diego 

Securing long-term disability benefits can offer a lifeline during challenging health circumstances. While the process might seem intricate, understanding the eligibility criteria can smooth your journey. At Bonnici Law Group, we provide guidance for LTD claims, help you navigate the process, and advocate on your behalf. We know exactly what makes you eligible for LTD benefits and can help you create an application that will provide you with the benefits and assistance you need and deserve. Call us at (619) 815-7790 or click here to schedule a FREE consultation.