What Factors Are Considered When Processing a Disability Claim?

There are many factors to consider when applying for long term disability benefits. Because disability benefits are such a valuable resource to many disabled workers, designed to address the economic ramifications of a claimants inability to work due to a serious illness or injury, it is important for long- term disability case managers to be thorough and consider all the facts in their decision to allow or deny a claim.

Below is a list of important factors that may be considered. For more information on factors impacting your claim, check out read our Applying for Disability page or watch a Your Disability Lawyers episode on What to Expect From the Disability Benefits Process.

Factors that may impact your disability claim

- Do you qualify as disabled?

Perhaps the most important question to ask when applying for disability insurance is whether or not you even qualify for benefits! Most long term disability insurance policies provide coverage for any illness or injury that prevents you from performing the essential duties of your occupation and meets the definition of "total disability" in your policy. Common exclusions found in most standard policies include: any disability resulting from self-inflicted injury or illness, any disability resulting from war or civil riot; any disability period during which you are imprisoned; any disability period for which you are on formal maternity or parental leave, and any disability for which you are not receiving appropriate medical treatment.

- Have you presented evidence to support your disability claim?

Your case manager will rely heavily on the evidence that you provide to support your claim. You can support your claim by providing any of the following documents related to your case: an official diagnosis, treatment records, medical test results, physician statements, employer statements, and your own personal statement about your ability to engage in daily activities.

- Have you met the time requirements?

In most cases, time is on the essence. Typically you would have to be working for your employer for a period of time (often 3 months) before qualifying to be included in your company's Group Benefit Plan, and generally there are time limits to all claims and any delay in proceeding with your disability claim may be subject to a deadline. You should refer to these provisions and/or contact a lawyer if you have not already done so.

The good news is that having an experienced member of the Share Lawyers team by your side during your long term disability case can send a strong message to your insurance company that you need to be treated fairly! Share Lawyers can improve your chances of winning your case by actively working to prove your entitlement to benefits and by motivating your insurance company to properly evaluate your claim and give you fair consideration.