How To Apply For Long Term Disability?
If you’re facing a serious illness or injury that prevents you from working, understanding how to apply for long term disability (LTD) benefits is crucial. LTD benefits can provide you with essential income support during one of the most difficult times in your life. However, the process to apply can feel overwhelming, confusing, and unfortunately, stacked against you. Whether you’re just beginning a medical leave or nearing the end of your short-term disability coverage, knowing your rights and how the LTD application process works is the first step in protecting your financial future.
What are Long Term Disability benefits?
Long Term Disability benefits (“LTD”) are a monthly income replacement benefit. The benefit is often available through a group insurance plan provided by your employer. Most LTD benefits will provide you with a percentage of your income should you become unable to work due to one or several medical conditions.
The LTD policy is meant to be a “peace of mind” agreement between you and the insurance company. The benefit is there to help provide income at a difficult time in a person’s life. However, it can often become challenging dealing with the insurance company who may deny your benefit altogether or force you to return to work when you’re not ready.
LTD benefits become available after a “waiting period” or “elimination period” which can be up to six months. This means, if you’re on a prolonged medical leave you may be eligible to apply for LTD benefits if you are approaching or have recently surpassed the waiting period. Each policy is different, and you can check the LTD benefit policy to confirm what your waiting period may be.
The insurance company will then determine whether you qualify for LTD benefits.
How do you qualify?
If your medical condition stops you from working, you may qualify for disability benefits.
Generally, each LTD policy will have two definitions. The first will evaluate whether your medical condition along with your restrictions and limitations prevents you from completing the essential duties of your own occupation.
After two years the definition changes and expands (and becomes more difficult). This is called the “Change of Definition” (“COD”) period. At the COD, the insurer will evaluate whether your medical condition along with your restrictions and limitations prevent you from completing the duties of any occupation that you are or may become reasonably qualified for by education, training or experience.
Once you apply, the pendulum swings and the insurance company is responsible for determining your eligibility for benefits.
How to apply for long term disability
You can request the application package from your LTD insurer. You can also ask a lawyer (ie: myself) for assistance in steps on completing the package.
Most applications require three forms:
- Plan Member Statement
This is a form completed by you outlining some background details and information on why you cannot work.
- Plan Sponsor Statement
This is a form completed by your employer. It includes details about your position, hire date and salary.
- Attending Physician Statement
This is a form completed by your doctor. Your doctor will be required to list the
condition(s) that prevent you from working and treatment.
Please note, any delay in submitting the application package can ultimately delay the insurers’ decision on your claim. Meaning it could delay your payments! Try to get forms submitted in a timely manner.
Common mistakes made by applicants that result in denied claims for long term disability:
-
Misclassification by the Insurer
I see this time and time again. Where a person submits an LTD application who is suffering from mental health issues that have become exacerbated by workplace issues. The insurer deems it to be a workplace issue and wrongfully denies benefits.
-
Refusing to Attend an Insurer’s Assessment
Your LTD insurer may schedule an assessment for you to attend. It could be an independent medical evaluation (“IME”), a vocational assessment or a functional capacity evaluation. As per the policy, you are required to partake in reasonable assessments as part of the ongoing adjudication process. Refusing to attend will likely trigger the insurer to withhold or deny your benefits.
-
Failing to Respond or Communicate with your Insurance Company
The Insurer needs to be able to reach you to provide information and updates about your claim. I’ve seen claims denied from failing to report a change of address and phone number where the insurance company couldn’t reach the employee. Keep your case manager informed of any changes to ensure you are accessible.
-
Late Applications and Coverage Issues
Last (but not least), late applications and coverage issues. It’s important to put the insurer on notice of your claim within time. A good rule of thumb, the earlier the better (but late is still better than never). If an application is submitted too late or if there is an issue with coverage, it could be fatal to your LTD claim. It’s important to seek advice early in the process.
If you are still unclear on how to apply for a long term disability claim or if you fit any of the above scenarios or have any questions about your current, future or pending LTD claim, please contact us! We offer a free consultation for short and long-term disability claims. Contact us online or call 416 640 2667.
Author – Aman Chaggar