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What Medical Conditions Qualify for Long-Term Disability Insurance?

If you're hurt or sick and unable to work, long-term disability insurance can help replace part of your income. Read on to learn what medical conditions qualify for long-term disability and how you can apply for coverage. Long-term disability coverage isn't available at Aflac, but we do offer short-term disability insurance that is available through worksite payroll deduction.

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Key Takeaways

  • Long-term disability insurance can help supplement up to 60% of your regular income when you’re unable to work for an extended period of time.1
  • Eligibility typically requires a qualifying medical condition as defined by your policy, and insurers often have different qualifying medical conditions. If a disability claim is denied, you can request an appeal or explore legal options.
  • While Aflac doesn’t offer long-term disability insurance, we do have short-term disability insurance that may be available through your employer.

What is long-term disability insurance?

Long-term disability insurance is a policy that helps supplement a percentage of your regular income after a qualifying medical condition prevents you from working for an extended period of time.1 Typically, short-term disability coverage is for medical conditions that keep you out of work for up to a year, while long-term disability helps cover time beyond that.

In either case, you may need to meet your policy's elimination period, which is the amount of time that must pass before benefits may be payable.

Otherwise, long-term disability works like any other insurance policy:

  • Enroll in a policy and pay monthly premiums to keep it active.
  • When a qualifying condition forces you to miss work, submit a claim to your insurance provider with documentation from a medical professional.
  • If your claim is approved, you’ll receive regular payments helping to cover a portion of your lost income for a set time period.
  • You must continue submitting proof of your disability to keep receiving benefits long-term.2

These payments can help you cover some of your living expenses while you recover, while health insurance and supplemental policies (insurance that offers additional coverage for expenses your primary insurance doesn’t cover), like hospital insurance, may help reduce your out-of-pocket medical costs.

Medical conditions that may qualify for long-term disability insurance

Qualifying conditions for long-term disability insurance vary between policies and insurers. Usually, long-term disability does not cover pre-existing conditions, but that will not necessarily disqualify you from applying for a policy.3 That condition may not be covered under the policy, depending on plan terms.

Examples of conditions that may qualify for long-term disability include:1,3

  • Severe back injuries
  • An illness that causes you to lose your eyesight
  • Mental health conditions that require intensive treatment, like bipolar disorder or clinical depression
  • Stroke
  • Cancer
  • An Illness that prevents you from staying at work, such as worsening heart disease
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How to apply for long-term disability insurance

Many employers offer long-term disability insurance plans as part of a benefits package. Otherwise, you can apply for individual disability insurance on your own.

Here are the steps you can take to apply:2

  • Gather your medical records: Your medical records will help determine the coverage an insurance company offers you and may influence your premiums.
  • Understand policy terms: Compare policy quotes and make sure you understand how to submit claims, what’s covered, and how much you can expect to receive for qualifying disabilities.
  • Pay premiums: When you’ve signed a policy, start paying your monthly premiums to keep your coverage active.
  • Submit a claim: When you experience a medical event that keeps you from working, submit a claim with detailed health records and a note from your doctor explaining why you’re unable to work.

Remember, you typically will not receive benefits for pre-existing conditions, so it’s important to apply and start paying for a long-term disability policy before you need it.

What to do if your claim is denied

Specific claims for long-term disability insurance may be denied because:

  • Your policy excludes your condition from coverage.
  • You don’t have the necessary documentation to prove your disability.
  • You forgot to submit claim materials, like medical records or a doctor’s or employer’s statement.
  • You provide inconsistent accounts of your disability that cast doubt on its legitimacy.
  • You missed the deadline to file a claim.
  • You have not received adequate treatment for your disability.

If your claim is denied, you can:

  • Review the denial notice to understand why your claim was denied.
  • Rectify the error, if possible, by providing documentation or contacting your insurance company to get a deadline extension.
  • If this doesn’t resolve the issue, file an appeal with the insurance company.
  • If it’s still denied, you may contact legal counsel.

Learn more about disability insurance

Disability insurance can be a valuable resource if you miss work due to a qualifying injury or illness. However, not all medical conditions qualify for long-term disability, so it’s imperative to get a policy before a medical event and review it to understand your coverage.

While Aflac does not offer long-term disability policies, we do offer short-term disability insurance that may be offered through your employer, which can provide cash benefits if you suffer a covered illness or injury and are unable to work. If you’re interested in applying for coverage, start chatting with an agent today.

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