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Must Your Disability Be an Injury to Qualify for Long-Term Disability Insurance Benefits?

According to the latest statistics from the Centers for Disease Control and Prevention (CDC), there are currently 61 million American adults living with a disability of some kind; that’s 26% of us. This figure includes 13.7% of people with mobility-related disabling conditions. However, it also encompasses the types of disabilities you might not automatically consider as such, like those related to independent living and self-care.

When it comes to long-term disability insurance, the definition can be even broader. Many people think of disabilities as arising from injuries or physically debilitating illnesses, but almost any condition can cause disability, for insurance purposes, if it prevents you from doing your occupation. If you’re wondering whether a specific illness or injury might qualify for monthly benefits under your employer-provided or individually purchased a disability insurance policy, this article will share all you need to know.

The Definition of Disability

Whether or not your long-term disability insurer regards you as disabled for the purposes of a claim will depend on the definition the policy itself uses. Regardless of whether your issues stem from an illness or an injury, your capacity to work in a full- or part-time job will be the factor your disability insurer uses to gauge whether you qualify for monthly benefits. There are two main categories of disability definitions you should be aware of.

Any Occupation

This is the more common definition of the two, particularly on employer-sponsored (ERISA) policies. An “any occupation” plan will regard you as disabled once you can no longer carry out the essential tasks associated with any full- or part-time job for which you are trained, educated, or suited. This is a difficult standard (particularly if your policy document uses broad language) so these policy terms are usually the most affordable.

Own Occupation

This is a more generous definition as far as policyholders are concerned. It regards you as being disabled once you cannot perform in the specific occupation you had directly prior to the onset of your claim. This means you can qualify as disabled and continue to claim monthly benefits despite being able to work in a position other than your previous job. Depending on the specific terms and conditions of your policy contract, you might even be able to take up employment (in a position other than the one you had directly before the onset of your claim) and continue claiming all your monthly disability insurance benefits.

Can Illnesses Be Disabilities?

If you have an illness that’s preventing you from carrying out full- or part-time work, it can qualify you for monthly disability benefits under an employer-provided or individually purchased long-term disability insurance policy. Our award-winning attorneys have worked with clients suffering from disabling illnesses like:

Every long-term disability insurance policy is different, so it’s important to research your own plan documentation to figure out exactly what types of conditions you’re covered for. Policy contracts can be extremely complex, so it’s best to seek the assistance of a top-class lawyer in the long-term disability field if you’re confused.

Can Psychological Issues Be Disabilities?

Nowadays, everyone understands that an illness doesn’t need to have physical symptoms to be seriously debilitating. Psychological health issues can completely destroy your ability to perform
in the workplace, and can therefore qualify you for short- or long-term disability insurance benefits. Some common mental conditions that give rise to successful claims include:

  • Bipolar disorder
  • Generalized anxiety disorder (GAD)
  • Post-traumatic stress disorder (PTSD)
  • Schizophrenia
  • Eating disorders
  • Depression

You should note, however, that almost all long-term disability insurance policies have mental nervous limitation clauses stating they will not pay monthly benefits in relation to mental health claims for longer than 24 months. For this reason, there can often be controversy over whether a given claimant’s disabling condition arises from physical or mental factors. Insurers will sometimes try to exploit the 24- month rule by arguing your condition stems from psychological causes, even where there are observable physical reasons for it.

Do You Need Help With Your Long-Term Disability Insurance Claim or Appeal?

The good news is that most long-term disability insurance policies allow a broad range of illnesses and injuries to qualify for monthly benefits. Regrettably, though, that doesn’t mean the claims process is straightforward. Insurance companies are notorious for exploiting any means possible to wrongfully deny or delay your disability insurance claim.

To minimize your chances of ending up in financial limbo by an unscrupulous insurer, you should work with a top-class long-term disability insurance lawyer. Contact an Ohio ERSIA lawyer today to schedule a free initial consultation, including a free policy analysis, claim assistance, or help with your appeal. Following an initial ERISA disability claim denial, quick movement is essential to ensure you submit a timely, thorough administrative appeal in advance of the deadline. Don’t wait to start the process.

DarrasLaw is Americas' most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long term disability and long-term care cases than any other lawyer in the United States.

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