Filing a long-term disability insurance claim requires careful attention to documentation, deadlines, and procedural requirements. The initial claim process sets the stage for everything that follows, and mistakes made early can create problems that persist throughout your claim. Understanding the application process and what documentation you need helps you submit a complete and compelling claim that accurately presents your disability and entitlement to benefits.
When to File Your Claim
Most LTD policies have an elimination period, typically 90 to 180 days, during which you must be disabled before benefits begin. However, you should not wait until the end of this period to start the claims process. Contact your insurer or employer as soon as you know your disability will be long-term to obtain claim forms and understand the specific requirements and deadlines that apply to your policy.
Many policies have time limits for filing claims, often requiring notification within a certain period after disability begins. Missing these deadlines can result in denial of benefits regardless of whether you actually qualify. Even if you are uncertain whether you will meet the elimination period, starting the process early ensures you preserve your rights and have time to gather necessary documentation.
Obtaining and Completing Claim Forms
LTD claims typically require multiple forms to be completed by you, your employer, and your treating physicians. The claimant statement asks for information about your employment, your disabling condition, and how it affects your ability to work. Answer every question completely and accurately, as inconsistencies between your application and other evidence can create problems later.
The employer statement verifies your job duties, earnings, and employment status. Ensure your employer accurately describes the essential functions of your position, as this information helps establish what you can no longer do. If the description does not accurately reflect your actual job demands, provide supplemental information explaining any discrepancies.
Physician Statements and Medical Evidence
Your treating physicians play a crucial role in supporting your claim. The attending physician statement asks doctors to describe your diagnosis, treatment, and how your condition affects your functional abilities. The physician's assessment of your limitations and restrictions forms the medical foundation of your claim and should clearly explain why you cannot perform your job duties.
Beyond the required forms, supporting medical documentation strengthens your claim. This includes office visit notes, diagnostic test results, imaging studies, hospitalization records, and specialist consultations. The more thoroughly your medical evidence documents your condition and its functional impacts, the better positioned your claim becomes. If your physicians have not documented certain limitations, ask them to add this information to your records.
Describing Your Job Duties
A critical part of your claim involves describing what your job actually requires. The insurer will compare your limitations against your job duties to determine whether you are disabled under the policy definition. Be specific about physical demands such as lifting, standing, walking, and sitting requirements, as well as cognitive demands like concentration, memory, and decision-making.
Do not understate the demands of your job. If your position required frequent deadlines, high-pressure decisions, or significant physical activity, make sure this is clear in your description. An accurate and detailed job description helps ensure the insurer evaluates your claim against what you actually did, not an oversimplified version that might make your limitations seem less significant.
Documenting Your Functional Limitations
Beyond diagnosis, your claim must demonstrate how your medical condition limits your ability to function. Describe in detail how your condition affects activities of daily living and work-related tasks. Explain what happens when you attempt activities, including symptoms you experience, how long you can sustain activity, and what recovery time you need afterward.
Keep a symptom diary documenting your daily experience with your condition. Note good days and bad days, activities you attempted, and how your symptoms responded. This contemporaneous record provides evidence of the real-world impact of your condition that medical records alone may not capture. Be honest about variations in your condition rather than overstating your worst days.
Coordination With Other Benefits
Most LTD policies require you to apply for other benefits, particularly Social Security Disability Insurance. The policy may reduce your LTD benefits by the amount of any SSDI you receive. Comply with these requirements promptly, as failure to apply for Social Security when required could result in the insurer reducing your benefits as if you were receiving SSDI even when you are not.
Many insurers will assist with or even fund your SSDI application because approval shifts costs from the insurer to the government. Take advantage of any assistance offered, but remember that SSDI and LTD have different definitions of disability, and approval for one does not guarantee approval for the other.
Common Mistakes to Avoid
Several common mistakes can undermine otherwise valid claims. Providing inconsistent information across different forms or during interviews raises credibility concerns. Understating your pre-disability activities or overstating your current limitations can backfire if the insurer discovers inconsistencies through investigation or surveillance.
Missing deadlines, failing to respond to requests for information, and not following prescribed treatment can all provide grounds for denial. Keep copies of everything you submit and send important documents by methods that provide proof of delivery. Follow up if you do not receive timely responses to ensure your claim remains active and progressing.
What Happens After Filing
After you submit your claim, the insurer reviews the information and may request additional documentation or clarification. A claims examiner may contact you for a recorded interview about your condition and limitations. Be prepared to answer questions honestly and consistently with what you have stated in your written application.
The insurer may also request independent medical examinations or records from providers you did not list. Cooperate with reasonable requests while understanding your rights. If your claim is approved, you will begin receiving benefits after the elimination period. If denied, you have the right to appeal, and the denial letter should explain the reasons and the appeal process.