Criteria for Determining Long-Term Disability

The basic working principle of long-term disability is that it should provide you with monthly benefits when a given medical condition prevents you from performing your duties. These are some of the benefits packages offered by employers to the employees. You can also opt to purchase your own package if your employer does not provide the same. Under these policies, the benefits offered are expected to replace a significant amount of your monthly income to enable you to meet your financial commitments.

The idea is for you to continue affording almost or the same lifestyle you were living before the medical condition took its toll. However, before getting all excited about the benefits, it is important to first ascertain whether you are qualified for the benefits. This article discusses some of the aspects considered by the insurance companies in determining what qualifies for long-term disability.

The distinction between Long-Term and Short-Term Disability Coverage

An important step to understanding the qualification criteria is by first being sure of the difference between a short-term plan and a long-term plan. When it comes to the short-term disability plan, the insurance provides you with a portion of your salary, typically about 40% to 60% in the event you are unable to work due to an injury or illness.

This plan covers you for a shorter period of time that extends to about one year. This policy will also stipulate the maximum amount of benefits you can claim. Therefore, you will only receive benefits either up to the amount covered or till when the stipulated time of your policy expires, whichever of the two comes first. Common illnesses covered by the short-term policy include child-birth, accidental injuries, arthritis, and back injuries.

Long-Term Disability

Under the long-term disability plan, you get coverage for a longer period of time than the short-term plan. This period may extend between five to 10 years provided you are disabled until the retirement age. The challenge with this plan is that you have to wait longer to receive the benefits, which may extend even to three months.

Medical Conditions That Qualify for Long-Term

From a general perspective, long-term disability is viewed from the perspective of a medical condition that exceeds more than a year or one that is likely to cause death within a short duration. Remember this a general view, hence the definition of wording may change depending on how each insurance company chooses to approach it. Also, it is important to note that the medical condition does not necessarily have to prevent you from no longer working to qualify as a long-term disability.

Instead, certain conditions that limit your ability to perform the job for which they have the training, experience, and skills to perform. For example, losing a leg may fail to qualify as a long-term disability for someone like an accountant, it certainly does for an individual that works in construction.

Based on the Social Security Disability Insurance (SSDI) program, medical conditions that can qualify as long-term disabilities fall under several categories. These categories include mental health problems, cancer, disorders of the nervous system, musculoskeletal disorders, cardiovascular diseases and injuries caused by accidents. Some of the medical conditions that fall under these categories include:

  • Heart disease
  • Bipolar disorder
  • Brain injury
  • Epilepsy
  • Leukemia
  • Hearing and eyesight impairment
  • Stroke
  • Back injuries
  • Alzheimer disease
  • Autism
  • Schizophrenia
  • Paralysis

The important thing to note is that this list can be extensive. Therefore, before taking up a plan with an insurance company, it is important to request for a list of the illnesses they consider as long-term disabilities.

Author: Robin Gupta