Long-term disability insurance provides income replacement if you cannot work due to a serious injury, illness or medical condition. The benefits are provided through a long term disability insurance policy either provided by your employer or purchased by you individually, directly with the insurance company. But even if you are covered through your job or individually, qualifying for long term disability benefits can be complicated.
Do I Qualify for Long Term Disability Benefits?
To qualify for benefits, you typically need to meet these conditions:
Your injury, illness or medical condition prevents you from working – either at your job (own-occupation) or any job (any-occupation), depending on your policy.
Your employer offers Long Term Disability coverage that you are enrolled in – or you purchased a private disability policy from an insurance company.
Medical evidence supports your claim – comprehensive documentation from your doctors proves your condition prevents you from working.
How to Apply for Long Term Disability Benefits
Review Your Policy – Understand how your plan defines disability and the timeline for benefits.
Gather Medical Records – Your claim needs strong medical documentation.
File the Claim – Submit your Long Term Disability application to the insurance company with all required documents.
Follow Up – If denied, you have the right to appeal (we can help).
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Why You Need a Lawyer
Long Term Disability insurance companies look for reasons to deny claims, and even small mistakes in your application can cost you benefits. A lawyer can:
Interpret policy language to ensure you meet the requirements.
Help gather and submit strong medical evidence that supports your claim, working with your physicians and other medical experts and specialists.
Handle the appeals process if your claim is denied.
Long Term Disability vs. Workers’ Compensation: What’s the Difference?
Many people confuse long-term disability benefits with workers’ compensation. Here’s how they compare:
Feature
LTD Insurance
Workers’ Compensation
Covers
Disabilities from any injury, illness or medical condition
Work-related injuries and illnesses only
Who Pays?
Private insurance policy (through employer or individual policy)
Employer’s workers’ compensation insurance company
Proof Required
Medical evidence proving you cannot work
Evidence the injury happened at work and that you cannot work
Time Limits
Benefits can last for years or until retirement age (depending on policy)
Temporary, partial or permanent benefits, depending on injury
Legal Recourse
You can appeal a denial and, if needed, file a lawsuit in federal court
You file a workers’ comp claim, appeal a denial and request a hearing
Key Takeaway: If your injury happened at work, you should qualify for workers’ compensation benefits. If your condition is not related to work, you may qualify for Long Term Disability benefits.
Under some long term disability policies, if your injury happened at work and you are covered by a long term disability insurance policy, you may be entitled to both.
Long Term Disability vs. Short-Term Disability: What’s the Difference?
Short-term disability insurance covers only temporary conditions and has a much shorter benefit period than Long Term Disability. It will usually cover the waiting period for long term disability, which is usually 3 – 6 months.
Feature
Long Term Disability
Short-Term Disability
Covers
Long-term or permanent disabilities
Temporary or short term medical conditions
Waiting Period
Often 3 – 6 months before benefits start
Often 0–14 days after injury/illness
Benefit Length
Years or until retirement, depending on policy
Weeks to months (usually up to 6 months)
Who Pays?
Employer-provided or private policy
Employer-provided or private policy
Key Takeaway: Short Term Disability helps when you’re temporarily out of work due to an illness or injury. If your condition lasts beyond your coverage period, you should be considered for Long Term Disability benefits to replace your income for a longer period of time if you cannot return to work.
What If My Short Term or Long Term Disability Claim Is Denied?
Denials happen often—but that doesn’t mean you’re out of options. Common reasons for denial include:
Insufficient medical evidence – More documentation may be needed.
Claim errors or missed deadlines – Small mistakes can lead to denials.
Policy exclusions – Some conditions may be excluded from coverage.
If your claim is denied, don’t wait. You typically have a limited time to appeal. Give us a call at 202-393-3320.
Frequently Asked Questions
What conditions qualify for Long Term Disability benefits?
It depends on your policy. Almost any injury, illness or medical condition like cancer, heart disease, neurologic conditions, back injuries, chronic pain, and mental health disorders often qualify if they prevent you from working in your own occupation. We have handled cases involving everything from early onset dementia to chronic orthopedic injuries, to rare neurological conditions.
Can I get Long Term Disability and Workers’ Comp benefits at the same time?
Sometimes. Workers’ comp pays for work injuries, but most long term disability policies cover accidents that happen at work, although there is often a reduction in the amount of long term disability benefits to account for the workers compensation benefits you are receiving – that is an issue you should have evaluated by a lawyer who handles both types of cases, because there is overlap between the two benefit systems so you want to make sure you consider everything in order to maximize your benefits.
How long do Long Term Disability benefits last?
It depends on your policy. Some last until retirement, usually to age 65; others stop after a certain number of years depending on when your disability started, especially if you became disabled close to or after age 65.
A denial is not the end of the road. It’s important to understand that the disability insurance company has discretion to deny claims, and that is a difficult standard to overcome, even though some claims are denied due to a lack of medical evidence or a lack of specific information regarding your ability to work. You have the right to appeal—but deadlines are tight, in policies governed by ERISA, that deadline is 180 days. And that is not a lot of time. Our appeals are usually 25 – 30 pages (single spaced) with another 100 pages of evidence. We can review your claim, strengthen your appeal, and fight for your benefits. Contact us as soon as possible to start your appeal.
Do I need an attorney for my claim?
You are not required to have an attorney, but Long Term Disability claims are complex, and insurance companies often look for reasons to deny benefits. An attorney can:
Help you understand your policy and gather the right evidence.
Handle appeals if your claim was denied.
The other thing to understand is that the appeal is critical. If you file a lawsuit against the disability insurance company, a federal judge will make the decision based on the administrative record – which includes your appeal and the additional evidence you submit. You probably won’t get the opportunity to create additional evidence.
Don’t wait—contact us today to get the benefits you deserve.
Many people come to us after a denial, but it’s always better to get legal help before filing to avoid mistakes. If you’re unsure, contact us for a consultation to discuss your options.
We’ve been helping people in Washington, D.C., Maryland, and Virginia with serious injuries for over 30 years.
You’re here because of a serious injury or medical condition. Now you’re dealing with an insurance company. You want your life back. We get that. We help guide you through this process so you can stand up to the insurance company and get back your financial security, control and independence.
Frank Kearney is an AMAZING attorney. He treated my son and I like family and continues to treat us as such. He took care of handling my son’s case with care and professionalism. He is the best lawyer you could have in your corner!!
