When my doctor told me I couldn’t return to work, I was glad I had made the decision a few years earlier to purchase long term disability (LTD) insurance through my employer. I thought I was set – piece of cake. It wasn’t as easy as I thought it was going to be, however.
First of all, you have to realize that your LTD carrier is in business to make money. What they’d really like to do is to collect premiums and never pay out benefits. Of course, they wouldn’t be able to do this long and stay in business. For one thing, they’d be faced with a gazillion lawsuits. So they do pay, but most are very selective about which customers receive disability benefits.
They want proof. They won’t just take your word about your disability. You can’t just say, “I can’t work anymore. I hurt.” This won’t cut it. They want x-rays, MRIs, CT scans, blood tests – stuff like that. Unfortunately, not every disabling condition can be proven with such tests. For example, some back ailments, joint pain, fibromyalgia, and chronic pain can’t be identified with traditional tests. Some emotional and mental conditions fall into the same category. This is where your doctors come into play.
Let’s use fibromyalgia as an example. No matter how much pain you’re in, this condition cannot be proven with a blood test or x-ray. Most general practitioners actually know little about it, so you need to be seeing a rheumatologist who specializes in fibromyalgia. His word and findings will carry a lot more weight with the insurance company than will those from a GP. If your disability is caused by something like panic disorder or clinical depression, you need to be seeing someone who specializes in that. Get the picture?
See your doctor on a regular basis. Make sure he documents everything. If he tells you that your MRI shows extensive nerve damage, have him write it down. The LTD folks aren’t going to read your MRI, and according to them, if it’s not written down, it didn’t happen. Every time you make a visit to a doctor’s office, emergency room, chiropractor, physical therapists, acupuncturist, clinic, psychologist, psychiatrist, counselor, or massage therapist, ask for a copy of any notes and tests. Take them home with you and make yourself another copy. Keep one set of everything in a large envelope and the other copy somewhere else. Keep one of the sets of copies next to your phone so that you’ll have the information readily accessible when your LTD representative calls with questions.
Fax everything to your long term disability company, AND send a set of copies via registered mail. They’ll request copies from your doctor, but from my experience, some doctors’ offices are slow about sending these. Also, sometimes the LTD carrier will say they were never sent, even though your doctor assures you that they were.
If your doctor is supportive of your claim, he’ll most likely be willing to write a narrative for your long term disability company and for Social Security. Most physicians charge extra for this, but it’s worth the price.
Keep a record of all the drugs you take and how much you spend on them every month. These include prescription drugs and over-the-counter medications. Also, be sure to document any adverse side effects from meds. You might take a drug that relieves your pain but makes you so dizzy that you have to lie down. Or maybe it “knocks you out.” Your goal is to show the insurance carrier why you can’t work.
Keep a journal of your illness, and be specific. “On March 2, my back hurt so bad that I had to take 2 pain pills (specify the drug) and stay in bed for 12 hours.”
When you fill out forms for your long term disability insurance company, be honest. Don’t exaggerate your illness or condition. Don’t say that you’re in excruciating pain 24/7 – they won’t believe you. Also, be specific. Saying “I can no longer lift a gallon of milk, so I have to buy milk in quarts now” is better than saying, “I can’t lift much.” Explain how your disability has changed your daily routine: “We had to hire someone to add handicap rails in our bathroom, living room, bedroom…”
Keep in mind that LTD insurance companies differ greatly, and even within the same company, representatives differ. The first guy I dealt with was a real butthead. He made it perfectly clear that they had no intention of approving my long term disability claim. He softened up a bit after he discovered that I was not going to be intimidated. He got me approved, but he was slow about following through. He soon disappeared. Maybe he was fired for being so nasty or so slow? Anyway, the next representative was nice, helpful, and very professional. She got my checks started quickly.
Once you’re approved for SSDI, you’ll get a very large check from the government that includes all your months of back pay. You have to inform your LTD carrier of this. In most cases, you can’t get LTD and SSDI in full. For example, if you have a group LTD policy through your employer, your disability benefit is based on a percentage of your normal salary. Let’s say that amount is $2,500 a month. You’ll get that amount monthly until your SSDI is approved. If your SSDI monthly amount is $2,000, your LTD payments will be reduced to $500 per month.
Here’s what often happens: When you get that first SSDI check that includes months of back payments, the amount could be as much as $35,000-$45,000 or more – depending on how long it took you to get approved. Don’t get excited – you have to pay that back to your LTD company. That’s included in the agreement with most long term disability insurance companies. A lot of times, the LTD company will try to settle with you. They’ll let you keep all that money if you agree to release them from future liability and payments. If you keep the cash, you won’t receive any more payments from your long term disability claim. I can’t advise you on this. You’ll have to carefully weigh the choice for yourself.
If you have a legitimate disability claim, be persistent and proactive. Don’t give up. If all else fails, hire an attorney who specializes in disability claims. An experience disability lawyer will know all the ins and outs of dealing with LTD companies, and you won’t have to pay him unless you win. True, he’ll get a chunk of your payment, but that’s a lot better than receiving nothing at all. Search online for the best disability attorneys - a not-so-good disability lawyer generally charges the same amount as a great disabilty attorney, so why not use one of the best?
I strongly advise anyone who’s employed or self employed to purchase long term disability health insurance. The premiums are modest, and if you pay them yourself, the benefits you receive are tax free. Unless a good policy is offered through your employer, I strongly suggest doing some comparison shopping. A good place to start is by getting quotes online.
Read more about long term disability and Social Security by clicking the article links below.
This article is accurate and true to the best of the author’s knowledge. Content is for informational or entertainment purposes only and does not substitute for personal counsel or professional advice in business, financial, legal, or technical matters.
Questions & Answers
Question: I am fifty-one-year-old female, and I was laid off from my job. I was then diagnosed with anal cancer two weeks later. My doctor said not to apply for unemployment compensation, as my chances were excellent to get disability benefits. I was denied. Can I still apply for unemployment benefits five months later? A=I am desperate. I can’t work, I have no money and soon I will have no place to live.
Answer: You should appeal the disability decision. Hire a lawyer, if necessary.
Pete deMatteo on November 17, 2017:
i work p/t at a library, approx gross pay approx. $435 for approximately 26 hours per average week. i have atro-fibrillation, myocardio, and bipolar disorder. i was told that i earned too much by an SSI agent who looked at my paycheck for a few moments. i was scheduled to see a shrink for approval around 8 years ago and he missed the appointment 2 times and then declared me disqualified based upon our session. i no longer see a cardiologist, although i am taking both heart medication and psychotropic meds as well. should i quit my job, which is becoming increasingly overwhelming, and which i cannot afford to do and/or hire a disability lawyer? i am currently 56 years of age. help, please!!
Paulc on November 01, 2017:
If you have applied for any disability insurance claim then you should assume every time you walk out the door you are being video taped. Some claim handlers are hoping you will break and have to return to any form of work because you have no money. It's not right, but over 50% of claims are denied and even if approved will be delayed as long as possible. Maybe 110 days
Jeff Hemingway on May 12, 2017:
Ive been waiting for over 30+years and I will lose every thing soon lawyers won't step up
H Lax on March 13, 2017:
Thanks for sharing this much needed information. I have arthritis and lung disease and have been denied. They said they knew I had problems but they felt I could do light work. Like there's anybody out there that hires people to do light work. Ten minutes into my last job I'd be in so much pain. I'd start crying before I left for work because I knew what was coming. Anyhow, I'm going to try again. Thanks again.
T-ruck on January 15, 2015:
Ugh... I am going though this now. I was receiving LTD benefits from the company I paid premiums to while I was working. After 2.5 years, they decided I was no longer disabled and cut me off. I am still fighting with SS and have an attorney who only does SS claims. I am 39, and my attorney says that is the main reason my judge denied my case in court. He appealed to the "appeal council" and I'm waiting on them. In the meantime, We are down to my wife's income only. I now have 2 attorneys, 1 for SSI and another for the LTD insurance. I will say the case that the insurance company thinks they have is a very shady one. They sent out one of their spies who saw me "going to the store, pushing a cart and bringing groceries into the house" They also claim I posted pictures of me golfing and at the bowling alley. Well, those were my kids and I was there as a spectator. I hope this new lawyer rips them a new one!
Laura on February 02, 2013:
I was turned down for LTD I worked 32 yrs. as RRT and before that was a ballet person. In my 20's I was told I have some scoliosis and wipe lash from a car accident. Things kept getting worse over the years I saw chiropractors and GP's and took over the counter drugs for the pain. Finally when thing s got really bad saw a pain management doctor that could see I had some real problems. That was about 12years age and was treated with nuproxin and Soma and injections. When that stopped helping I went to see someone else about 5 years ago. I have headaches arm pain thoracic pain neck pain leg and foot pain hip pain and all of this is chronic. I received the injections which didn't help anymore or only for a few days. I was put on hydrocodone, Morphine , Valuim ( I have bad muscle spasm too ) my right arm is always weak and elbow neropathy both hands have carpal tunnel so I have pain there too. The worst of this is that is I always hurt even with the meds. I can't run to codes push flowmeters into the wall push ventilators lean over patients pull patients lift them and so on. I would go home and cry almost every day until the drugs would kick in a little. I have had MRI's , nerve studies and they all confirm my areas of complaints. My doctors even said at one point I could also have fibromyalgia because of so many areas of pain and that I have IBS which is common with fibromyalgia. 8 or so disc are bulging with spurs and the reverse cervical neck and muscle spasms never stop hurting along with my thoracic area. Sorry this is lengthy. I just can't believe that after 6 months of STD this company would tell me I am fit to go back to work. I am getting a lawyer which is just what you want to do when you don't have a pay check any more and you worked until the only think that ever sounds good is taking my meds and getting into bed. Not to sleep though that I hate because the headaches after sleeping means I start all over again.Well enough said oh wait I am being treated for pre diabetes too so I get to stick my self and more meds for that. The depression is being helped with meds too. Ok now get to work .......... code blue room 2 stat
Tiffany Delite from Wichita, KS on November 01, 2012:
thank you for this great article...and the information is very accurate in my experience. it can be so disheartening and so frustrating! i wish you the best as you move forward in life...blessings!
superpipoy on July 01, 2012:
This is a very helpful information for me. I should have seen this a long time ago. I was having a hard time getting my insurance approved when i had my car accident last year. Thanks for sharing though.
Floyatta on October 05, 2011:
I noticed that you never used RA as a qualifying ailment.I have RA plus a bulging disc in my neck as well as nerve problems in my back.which one of these would be the best for disability ss?I guess the RA probably gives me the most pain.
mike on August 21, 2011:
I just recevied my ssd back pay check and it is less thab what I was getting from LTD. Will I now owe LTD. the difference
Sarah L on August 21, 2011:
I had shoulder surgery 5 months ago. My current doctor has not released me to return to work (I lost my job because of this..FMLA ran out) Anyways, I have a LTD claim pending and was wondering if I can get a second opinion about weather or not my shoulder was repaired correctly. Surgeon is very vague in explaining what or how he repaired it. He also doesn't remember meds. he has perscribed or weather I am still doing therapy. He is just a quack! Please help. oh, and will I have to pay to get a copy of my records from him. Thanks for listening
Holle Abee (author) from Georgia on August 01, 2011:
Lisa, I wish I could provide you with answers, but there are just too many variables. I'd think it a good sign that you didn't get turned down quickly. I wish you the best of luck!
LisaWalden on July 29, 2011:
I am so glad that I found this site. I am waiting on a decsision on my case. My questions is, I was scheduled to see a SS doctor because they said they didn't have enough medical information. Then I received a letter saying that I did not need to go to that appointment because they had plenty of medical records. Is this a good or bad sign? I have lupus and 15 years of medical records. I have had 2 recent infections & 1 lupus flare in the past 2 1/2 months. I have called my case worker each time to tell her about new medications. They are reviewing the medical portion right now. I wonder how long that takes? Any input would be very much apprechiated. Thanks for listening.....
Holle Abee (author) from Georgia on April 16, 2011:
True, Sarah. Some people are too quick to throw in the towel!
Sarah Hill on April 15, 2011:
I work for a lawyer that handles disability denials. I just wanted to let all of you know, please do not give up! There is hope for your case. If we can help let me know. Either way, please have faith and good luck!
Holle Abee (author) from Georgia on April 08, 2011:
DePuy, my long term disability insurance saved us from going broke!
DePuy Pinnacle Recall on April 06, 2011:
Insurance can be a great asset for people with long term disabilities. Thank you for all of your suggestions and for sharing your experiences with us.
Holle Abee (author) from Georgia on November 14, 2009:
Hi, Ethel! Do you have something similar over there?
Thanks for reading!
Ethel Smith from Kingston-Upon-Hull on November 14, 2009:
Interesting and very useful for those in the States
Holle Abee (author) from Georgia on November 13, 2009:
True, Putz. I think a lot of depends on the case worker you get...unfortunately.
Thanks for your input!
Putz Ballard on November 13, 2009:
Habee, I also know some folks who didn't have any difficulties in getting a disabled status. What really burnsy hide are these people who have one baby right after another and maybe one has problems which may qualify it for SSI, next thing you know all five or six have the same issue and are drawing SSI checks, no need to find a job now. Income is set at least for the time the children are out of school.
Holle Abee (author) from Georgia on November 13, 2009:
Thanks, HH. It wasn't too bad!
Hello, hello, from London, UK on November 13, 2009:
Hello, habee, and so sorry for reading all about your health I know insurance companies are the last who like to pay out. I wish all the very best.
Holle Abee (author) from Georgia on November 13, 2009:
Thanks, Putz. I've heard some horror stories! Then again, I know of folks who really aren't disabled to have an easy time getting approved. Go figure.
Thanks for reading!
Putz Ballard on November 13, 2009:
Great hub, many have a very hard time, guess with three artificial joints the Social Security people figure I was worn out and approved mine on the first pass. Great hub, Habe