What Medical Conditions Qualify for Long-Term Disability?

Long-term disability is a form of insurance that covers 40-60% of your income in situations where you are hurt or become ill for a period of time. Long-term disability insurance may be a policy purchased through your employer’s benefits plan or may be a self-purchased policy.

Long-term disability applies to a wide range of situations, but insurance companies may deny coverage. If you are facing a denial or need help receiving compensation owed to you, contact our long-term disability attorneys at Pond Lehocky Giordano for a free consultation.

Medical Conditions Covered by Long-Term Disability

Long-term disability coverage can differ from one provider to the next. To know what is covered with your policy specifically, you will need to review the details of your policy. The following are some of the most common medical conditions long-term disability typically includes:

Mental Health Disorders

Numerous mental health disorders may qualify for long-term disability benefits. This may include:

• Depression
• Post-traumatic stress disorder (PTSD)
• Anxiety disorders
• Bipolar disorder

Typically, policies cover the acute onset of these conditions, which may mean a sudden worsening of a pre-existing condition. They may cover the first onset of these conditions as well.

Cardiovascular Disease

Most long-term disability policies include coverage for cardiovascular conditions that limit your ability to work. This might include:

• Congestive heart failure
• Heart attacks
• Severe coronary artery disease

Cardiovascular conditions may also occur suddenly, such as with a heart attack, or they may happen over time, diagnosed by your doctor and requiring immediate intervention.

Musculoskeletal Disorders

A variety of musculoskeletal disorders may apply. If you are hurt in a car accident or fall, for example, you may have coverage for injuries you suffer. It may also cover diseases you are diagnosed with that limit your ability to work. Examples include:

• Back pain and injuries to the spinal cord
• Fibromyalgia diagnosis
• Muscle or tendon injuries that limit your mobility
• Arthritis
• Degenerative disc disease
• Broken bones that prevent you from working in any capacity

Long-term disability typically applies in these situations if you will need surgery or need a long period off for recovery. Most policies will also only cover situations where you cannot work as expected or with limitations.

Neurological Disorders

Some neurological disorders may receive coverage depending on the policy details. Examples may include:

• Parkinson’s disease
• Multiple sclerosis
• Epilepsy
• Strokes
• Alzheimer’s disease

These conditions may develop over time or may involve an acute episode. Policy limitations for pre-existing conditions are somewhat common but differ widely between policies.

Respiratory Disorders

Long-term disability may provide coverage for a variety of respiratory disorders. That includes:

• Asthma
• Chronic obstructive pulmonary disorder (COPD)
• Other lung disorders

Those who have these conditions may receive coverage when a sudden onset occurs or in situations where you have a serious complication.

Other Types of Medical Conditions Covered by Long-Term Disability

Victims of other types of injuries or illnesses may have coverage. In most situations, coverage is dependent on the severity of the condition and your inability to work. This might include:

• Onset or complications of HIV/AIDs
• Cancer of all types
• Type 1 or type 2 diabetes
• Thyroid disorders
• Immune disorders
• Cirrhosis
• Crohn’s disease
• Chronic kidney disease

Your long-term disability policy could be very different from others. It is always a good idea to review coverage before accepting a policy.

Limitations on Coverage for Long-Term Disability

Just having one of these medical conditions does not mean you automatically qualify for long-term disability. If the condition occurs, but you can still work, you may not be able to file a claim.

If, for example, a condition like cancer may mean that the disease warrants a period off from work for treatment. However, if the condition can be controlled or cured, long-term disability may not remain in place. Every situation is very different and requires a doctor’s proof that you cannot work.

Who Is Eligible to File a Long-Term Disability Benefit Claim?

Long-term disability benefits are dependent on policy terms. Most of the time, there are multiple factors that play a role in whether your medical condition meets the specific disability requirements listed under the policy. Determination often starts with a medical condition. 

The policy may be an “own occupation” policy, which means it defines a disability as the inability to perform the duties of the job you normally do. Note that what your job requirements and work duties are is not necessary based on what you personally do, but how the national economy defines the work you do. Most of the time, these types of policies last 24 months at the most.

A second form is “any occupation” coverage. This typically happens after those 24 months. You will need to show proof of your inability to do any type of work or earn a percentage of your pre-disability income.

Proving a Disability

Proof of a qualifying disability often includes images and statements from your doctor, as well as testimony from your employer or other party about the work that you do. You will also need to complete a Functional Capacity Evaluation (FCE) or an Independent Medical Examination (IME) if the insurance company wants additional information or insights into your care.

Obtaining a Long-Term Disability Attorney Is Beneficial

In some situations, especially if an FCE or IME is requested, it is critical to seek the help of a long-term disability attorney. Your attorney will work with you and the insurance company to ensure you are being treated fairly.

If you are facing any concerns about your ability to qualify for long-term disability and you have one of these medical conditions or another, seek the help of Pond Lehocky Giordano. We will offer a free consultation to help you determine what your legal rights are.

Contact Pond Lehocky for Help Today

Numerous medical conditions qualify for long-term disability savings, including conditions such as cancer, chronic illnesses, and neurological disorders. Proving you cannot complete your job duties or any job duties is essential, but a challenging part of this process. Call Pond Lehocky Giordano or submit our contact form for a free consultation to learn more about your rights.