What Qualifies Me For Long-Term Disability?
My name is Brandon Osterbind and I am an injury and disability attorney in Central Virginia. I help people whose long-term disability claims have been denied. Today, let’s talk about what would qualify someone for long-term disability under an insurance contract provided by an employer.
First of all, every insurance policy is different. They all have different definitions of total disability, and it’s important to make sure that you know the definition of your policy. Still, a lot of insurance policies use similar language and apply similar terminology.
What does it mean to be totally disabled
One of the many definitions that we typically see is that you are totally disabled if you are unable to perform the main duties of your occupation or the essential duties of your occupation.
And usually, the question is, “Does that mean that I can’t do any of them? Or is it enough if I can’t do any one of them?” And the answer is, it depends. It depends on the insurance policy, what the terms of the policy say, and also on how the courts have interpreted that language in your jurisdiction.
What medical conditions would qualify as a disability?
What would qualify you for a type of disability that would be provided for under one of these insurance policies? Well, there are several medical conditions and probably too many to sit here and name. But I can tell you about just a couple of them that I’ve encountered.
Traumatic brain injuries
One of the many types of injuries that we often see in car accidents or that we’re learning more and more about from football game injuries are traumatic brain injuries. Even a concussion can produce what is called a mild traumatic injury. And even a mild traumatic brain injury can produce a lot of symptoms that completely and utterly render you unable to work.
In addition to that, there are other physical conditions that are not acquired through trauma. For example, I had a client who had a diagnosis for Graves’ disease. And Graves’ disease is a thyroid condition. But your thyroid essentially regulates all of the chemicals throughout your body.
It affects your hormones, your testosterone, your cognitive abilities, your anxiety amd your depression. It affects everything. This is a physical condition that has a lot of mental health manifestations and a lot of cognitive manifestations.
And these are just a couple of examples that have rendered some of my clients completely and utterly unable to work. And I say completely and utterly unable to work, yet there are some things that they can do. There are things that are activities of daily living that they can do.
What they cannot do in the workplace
But there are things in the workplace that they would be required to do that they simply cannot perform anymore, or they cannot perform them to a degree that is acceptable in the workplace. Perhaps they cannot perform the main duties of their occupation. For example, if you can’t sit down and create a budget when that’s one of your main duties, then you can’t do that job anymore.
Own occupation versus any occupation
A lot of insurance policies will have what is called an “own occupation” definition and an “any occupation” definition. The “own occupation” definition is usually relevant for the first year or the first two years, depending on the policy. So you are defined as disabled from the date of your disability until one or two years beyond that.
After that period, the “any occupation” definition of disability would take over. And that “any occupation” definition is much broader. It’s harder to qualify for disability under the “any occupation” definition than it would be to qualify under the “own occupation” definition.
That’s because maybe you can find a job that doesn’t require you to create a budget. And those types of jobs are much more readily available than those higher-level jobs that require you to do challenging cognitive things.
These are just a couple of examples that we’ve seen most recently. There are other types of disabilities, i.e., physical disabilities, that would also make you physically or mentally unable to work.
Does your condition qualify you for long-term disability?
Any type of condition that keeps you from performing the main or essential duties of your occupation could qualify you for long-term disability benefits under your policy.
If you’re wondering whether your condition qualifies you for disability under the definitions of your policy, give us a call. We’d be happy to look at your policy and at your condition, your symptoms and your doctors reports. And we’ll give you advice on how to fit those together so that your long-term disability claim is approved the first time.
That way, we can get you on claim and keep you on claim for as long as your doctors say that you’re disabled. I hope this discussion has been helpful. If you have any questions, give us a call or send us an email and we’ll be happy to help.