Many workplaces or private insurance plans provide their employees with short and long-term disability benefits if you are unable to work due to an illness or other medical condition. If you are unsure about your plan, contact your insurance provider for more information. If possible, use any leftover sick days you have accumulated with your employer, then apply for short-term disability.
To qualify, most insurance policies require a medical report from your doctor or specialist that details the illness or injury you’ve suffered. The report must also include details outlining how your condition disables you from performing specific tasks and functions of your job. Generally, doctors may also include a date when you can expect to return to work.
Once the short-term disability has come to a close, you may gain long-term disability benefits. But, new medical examinations and applications are required.
Do You Qualify for Disability Benefits?
Even if you were receiving short-term benefits, the same injury may not entitle you to long-term benefits. Your eligibility for long-term disability depends on your policy’s exclusions about whether your disability stops you from doing your current job or any form of employment.
A policy’s exclusions on this matter will fall into one of these three general categories: regular occupation, any occupation, or own occupation. Here’s what each term means:
“Regular occupation” is the role you perform when the disability is incurred. Some insurance plans use this term to indicate their benefits are available if you can no longer perform all or most of your tasks and duties associated with your “regular occupation.” In this case, you cannot be denied coverage even if there are other jobs outside of your “regular occupation” which you could still perform.
To gain benefits, some plans require your disability to prevent you from working
“any occupation” that your experience, skills, and education are reasonably suited for. If you can be “gainfully employed” in any position, you may be denied long-term disability benefits, even if the job or position you are able to perform is not one you would normally consider.
It can be a challenge to meet the standards for being disabled beyond “any occupation.” Sometimes, people are wrongfully denied long-term disability on this basis.
This last term is used by insurance plans to describe that you may receive benefits when you are no longer able to perform the job you were trained for or your “own occupation.” You have to be working during the time your disability was incurred to qualify for this kind of policy. However, the open nature of the term “own occupation” means you may be able to continue getting long-term disability benefits even if you start a new career.
If you’ve been injured and have been denied short or long-term disability, Contact Zayouna Law for a free consultation regarding your LTD needs. We’ll help you navigate insurance legal documents to ensure you receive the benefits you deserve.