What You Need to do When Making a Long-Term Disability Claim

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Maybe you’ve been severely injured in a car accident. Or fibromyalgia causes your entire body to ache with pain. If you’re suffering from a debilitating medical condition that prevents you from working, you will need financial support to cover your living expenses and medical treatments while you are unable to work.

If your employer’s group benefits plan or your own private policy includes long-term disability coverage, the good news is that financial support is available to you. However, the bad news is that making a long-term disability claim requires lots of time and legwork and that, despite your efforts, it may be denied, as claims commonly are. 

If you need to make an LTD claim, consider seeking the help of a disability lawyer. They know what insurance companies require to approve an application, and many won’t charge a fee unless they get you money from the insurance company. They also know how to get you the benefits you deserve if the insurance company denies your claim. Below are the steps you’ll need to take to apply for LTD benefits.

1. Consult Your Insurance Policy

While long-term disability plans cover a wide variety of medical conditions, there may be a few that are excluded from your policy. Confirm that your condition is not one of those exclusions before starting your claim. There are also deadlines to file a claim, so you need to ensure yours has not already passed.

Reviewing your policy will also inform you of the application, claim and decision procedures which helps you complete the forms more accurately and gives you an idea of what to expect. 

2. Speak With Your Healthcare Provider

Whether you’re already in treatment for your disability or you’ve just started, your doctor should already know that you’re applying for LTD benefits. Your healthcare provider is integral to your LTD claim and must be in the loop from the beginning.

accident emergency

 The insurance company will want to see that you’ve already begun treatment and are getting it from the right healthcare providers. The sooner you inform your doctor of your claim, the sooner they can start you on a treatment plan that addresses your condition and begin the process of getting you in to see specialists if needed.  Many policies require your doctor fill out a portion of the application form (see below).

3. Get the Forms You Need

You may be able to download the long-term disability claims from the insurance company’s website or an employee portal, if not, your work should provide you the correct forms. 

Each insurance company has its own application forms, but you can generally expect them to include:

  • A claimant’s statement – This is the section you fill in. You will have to provide details about your medical condition, how it affects your ability to work, your medical history, etc. You will also be asked to provide authorization to the insurance company to speak directly with your healthcare providers and legal representative. 
  • An employer’s form – Your employer will complete this section and send it directly to the insurance company.
  • A physician’s statement – The primary care provider treating you for the cause of your disability will fill out this section. They should also attach all medical records, tests, specialist reports, etc., that prove your medical condition and show precisely how it prevents you from performing your specific job tasks.  This statement is crucial to your claim and your doctor must support the fact that you are totally disabled from working.

4. Submit Your Claim and Wait

Make sure to follow the insurance company’s instructions for submitting a claim to the letter. If they don’t receive it or get it late, you may have to start all over again. The insurance company will assign a case manager to your application. This person will probably interview you regarding your claim. You may also be asked to attend an “independent medical examination.” Failing to attend will likely result in your claim being denied. 

The insurance policy will state how long it takes to receive a decision on your claim. The average is between 30 -90 days.

If your claim is approved, you and your employer will be notified. The approval letter will provide details about the amount of benefits you will receive, payment frequency and instructions to maintain your eligibility.

If your claim is denied, you’ll be given a reason for the denial and advised of your right to appeal the decision. If you didn’t retain a disability lawyer at the outset, now is the time to do so. They know how to get you benefits despite the denial, but the options for achieving this are time-sensitive, so speak to an LTD lawyer immediately after receiving the denial letter.