3 Legal Components of Applying for Long-Term Disability

When a serious illness or an unexpected injury leaves you unable to work, your entire world is turned upside down. Your primary focus becomes your health and your recovery. But as you begin to navigate this new reality, you are faced with a second, equally daunting challenge: the complex and often adversarial process of applying for your long-term disability (LTD) benefits.

This is not just a matter of filling out a few forms; it is a formal legal claim against a large insurance company. In this confusing and often painful time, having an experienced disability lawyer on your side from the very beginning can make all the difference. They are the expert guides who can help you navigate the legal maze and protect your rights.

To get started, it helps to understand the key legal components of any successful disability claim.

1- Understanding Your Policy's Definition of "Disability"

This is the single most important and most misunderstood part of any LTD claim. The insurance company does not use your doctor's definition of disability, nor do they use a common-sense definition. They use the specific, legal definition that is written into your insurance policy document, and you must prove that you meet that exact definition.

• "Own Occupation": This is the more favorable definition. It means you are considered disabled if you are unable to perform the material and substantial duties of your own specific job.

• "Any Occupation": This is a much stricter and more difficult standard to meet. It means you are only considered disabled if you are unable to perform the duties of any job for which you are reasonably qualified by your education, training, and experience.

Many policies will use the "own occupation" standard for the first 24 months of a claim and then switch to the much tougher "any occupation" standard.

2- The Burden of Proof is On You

In any legal claim, the person making the claim has the "burden of proof." This means that it is your responsibility to provide a mountain of clear, consistent, and objective evidence to prove your case to the insurance company. The insurance company does not have to prove that you can work; you have to prove that you cannot. This is why your medical records are the absolute foundation of your entire claim.

• Consistent Treatment: A record of regular visits with your treating physicians.

• Objective Evidence: Test results like MRIs, CT scans, and lab work that support your diagnosis.

• A Detailed Physician's Statement: A strong, detailed report from your doctor that clearly explains your diagnosis, your symptoms, and, most importantly, your specific physical and/or cognitive limitations.

3- Navigating the Appeals Process and Strict Deadlines

It is a frustrating and unfortunate reality that many valid, initial LTD claims are denied. When this happens, you have the right to appeal the decision. However, this appeals process is governed by a strict and complex set of rules, and there are non-negotiable deadlines.

If your policy is through your employer, it is likely governed by a federal law called ERISA. ERISA has very specific rules and timelines for these appeals. Missing a deadline by even one day can be fatal to your claim, permanently barring you from receiving your benefits. This is an area where the guidance of a legal professional is especially critical.

Applying for long-term disability is a complex legal journey that happens at one of the most difficult and vulnerable times in a person's life. By understanding the legal components of your claim and by seeking professional legal guidance early in the process, you can significantly increase your chances of a successful outcome and focus on what truly matters: your health and your recovery.