Do you need to apply for long-term disability benefits? Are you looking for a simple step-by-step guide? If so, you are in the right place. Follow our 7-step process to complete your application for long-term disability.
This article is part of our Ultimate Guide to Long-term Disability.
- Step 1: Determine when the waiting period ends
- Step 2: Make sure your doctor supports you in applying for long-term disability
- Step 3: Tell the insurance company you want to apply for long-term disability
- Step 4: Fill out the forms in the application package
- Step 5: Send the application and supporting documents to the insurer
- Step 6: Cooperate with reasonable requests from the insurer when applying for long-term disability
- Step 7: Wait for the insurance company’s decision
- Next Step – Download our Free Book
Step 1: Determine when the waiting period ends
All long-term disability plans have something called a “waiting period.” You can only qualify for long-term disability benefits if you are off work for an extended time. The waiting period is simply the length of time you must be off work for your disability to be considered “long-term.” This is in contrast to a short-term or temporary disability.
There is no standard length for a waiting period. It can vary from plan to plan and may range from 12 to 52 weeks. However, the vast majority of long-term disability plans fall in the 17- to the 22-week range. Your insurance policy or group benefits booklet sets out your waiting period.
You can start your application before the waiting period ends. You want to apply early so your benefits can be approved and start immediately once the waiting period ends. The benefits administrator needs time to process your application. This can take four weeks or more. If you wait until the waiting period ends, then there could be a delay until your payments actually start. The delay may be a month or more. So, we recommend starting your application at least four weeks before the waiting period is over.
Step 2: Make sure your doctor supports you in applying for long-term disability
Before starting the application process, you need to know that your doctor will support you. You will never be approved for long-term disability if your doctor disagrees. Some doctors will recommend short-term disability but may hesitate to recommend long-term disability. They may believe that trying to go back to work after a short break is the best thing for you.
It is absolutely vital have a clear and frank conversation with your doctor. You need to know for certain if they will recommend that you stay off work after the waiting period expires. If your doctor supports you, then you are good to go. You can start your application. However, if your doctor doesn’t support you, or recommends you try and return to work, you will have to delay your application until you get their support or figure out an alternative.
Step 3: Tell the insurance company you want to apply for long-term disability
Once you have your doctor’s support, the next step is to tell the insurance company that you want to apply for long-term disability. Exactly how to apply for long-term disability will vary from plan to plan. So, you need to ask your insurance company what you need to do.
There are two possibilities:
First, you may not have to do anything more. If the insurance company is already paying your short-term disability, then they may consider your long-term disability automatically. Or, they may only need an updated medical report from your doctor.
Second, the insurance company may ask you to fill out an application package. This is common when the insurance company has not managed your short-term disability claim. They will send you the application package, which usually includes an application form, a medical form, and an employer form.
Step 4: Fill out the forms in the application package
The application package will usually include three forms:
- Application form (you fill out)
- Medical form (your doctor fills out)
- Employers form (your employer fills out)
You are responsible for filling out the application form. Many of the questions may seem straightforward but take your time. As questions about your work, medical conditions, symptoms, and limitations will require special care. If you run out of space on the form, it’s perfectly fine to write in the margins. You can even attach a separate sheet of information — but make sure you indicate that you have done this.
It is crucial to get the application submitted as soon as possible. All insurance plans have a deadline. It is usually 3 to 6 months after the end of your waiting period. We recommend you get your application in before your waiting period ends. However, if you have missed the deadline to apply, reach out to us or another law firm to learn what you should do.
The doctor’s form is the most important part of your application for long-term disability. The insurance company cares most about how your doctor describes your medical condition, limitations, and treatment plan. You can give this information to the insurance company yourself. However, they will not take it seriously unless it comes from your doctor.
It is your responsibility to get the doctor to fill out this form. We recommend you make an appointment with your doctor where you exlusively deal with this form. That way, the doctor knows it is coming. Do not try to fit it in during another appointment. Do not drop it off for the doctor to fill out in their spare time. It is best to have the entire appointment time devoted to the form so the doctor can ask you questions while filling out the form.
You have to arrange for your employer to fill out the employer’s form. This form asks them to confirm your job title, salary, hours of work, job duties, and responsibilities. Ideally, you will want to review this form before it gets sent to the insurance company. You want to do this to ensure the information on it is accurate. Some employers will provide incorrect information either by mistake or on purpose.
If you notice incorrect information on the employer’s form, do not write on it or edit it in anyway. It is critical that the employer’s form only has your employer’s writing. Otherwise, it may look like you are tampering with the form. If you see incorrect information, start by bringing this up with the employer. It may have been an oversight. They can correct it on a new form. However, if the employer refuses to correct the information, you can address this in a separate letter attached to your application. Do not write anything on the form.
Step 5: Send the application and supporting documents to the insurer
Ideally, you want to send your application in one package with all supporting documents. This package should include the following:
- Your application form, completed and signed
- Sheet attached to the application form with any additional information that would not fit on the form
- Medical form completed and signed
- Employers form, completed and signed
- Cover letter
You might not be able to send everything at once. For example, some doctors and employers will insist on sending their forms directly to the insurance company. Or, if someone takes a long time to do the form, you should get your application and supporting documents in as soon as possible. That way, you will at least start the process so the insurance company can assign a claim representative to your long-term disability claim. Sometimes, the claim representatives can help you get the doctor or employer to get their form in.
Step 6: Cooperate with reasonable requests from the insurer when applying for long-term disability
A cooperative mindset will go a long way when applying for long-term disability. You should act in good faith with any reasonable requests from the insurance company. The following are some common requests:
- Speak with them by phone to answer questions
- Provide copies of your medical records
- Ask your doctor to give more information
By reasonable requests, I don’t mean what you personally feel is reasonable, or what your doctor thinks is reasonable. Rather, I am referring to what a court would determine is reasonable in the circumstances. You need to follow this standard when deciding whether to deny a request from the insurance company.
Some people have the instinct to provide the insurance company with as little information as possible or to object requests for information or documents. We have seen people make excessive or unfounded complaints about privacy violations and other petty problems.
Please resist the urge to do this. When you act unreasonably with the insurance company, it hurts your credibility. Credibility is the key issue in most long-term disability claims. If people see you as credible, your claim will have a much greater chance of being approved. If you are not credible, there is a much smaller chance you will get approved — even if you are legitimately disabled and should qualify.
A denied claim will ultimately end up in court. You want the judge to conclude that you went above and beyond to be helpful and acted reasonably at all times. If the judge sees that you were unreasonable or petty and sees the insurance company acting reasonably, then you are sure to lose your claim.
Step 7: Wait for the insurance company’s decision
The final step in applying for long-term disability is to wait for the insurance company’s decision. The representative may tell you over the phone, but usually, you will get an email or letter. It usually takes 30 to 60 days to get a decision. However, it can take longer if the employer or medical form gets delayed or if you get delayed in filling the insurance company’s other requests for information.
If the insurance company approves your application, make sure to read the letter carefully. Sometimes, it may only be a temporary approval. Sometimes, approvals are conditional. You might need to get them other outstanding information by a deadline.
If the insurance company denies your application, you have the right to ask them to reconsider, which is called an appeal. I strongly recommend you consult with us at Resolute Legal or another disability law firm before going ahead with your appeal. Each appeal needs to be done strategically in order to maximize your chances of success. The right approach for you will be different from what others should do. This is because no two situations are the same.
Next Step – Download our Free Book
Do you want to learn more? Our free eBook explains how to go beyond the basic application to give yourself a better chance of success.