Getting sick or hurt can flip life upside down. When you cannot work for months, the question becomes simple and scary at the same time: how will I pay the bills? Long-term disability benefits exist to replace part of your income so you can focus on treatment and daily living. Here is a clear, nationwide look at how these benefits work and what to do if a claim is denied.
Where LTD benefits come from
Long term disability coverage usually comes from one of two places:
- An employer group plan. Most of these are governed by a federal law called ERISA. That law sets strict timelines and rules for claims and appeals.
- A private policy you bought on your own. These are controlled by your state’s contract and insurance laws.
What LTD benefits cover
Policies differ, but many pay a percentage of your pre-disability earnings after a waiting period. Early on, some policies define disability as being unable to do your own job. Later, many switch to an any-occupation standard. Knowing when that switch happens matters because it can change whether you stay eligible.
Filing a strong claim
Give complete, consistent evidence. Your claim is stronger when your doctor’s notes, test results, and daily-living limits all match. Describe what a typical bad day looks like. Explain how symptoms affect focus, pace, or reliability, not just strength or mobility. Keep copies of everything you submit and note every call or letter.
If you get a denial
Read the denial letter closely. It should explain the reasons and the deadline to appeal. For ERISA plans, the appeal is your best chance to add missing records and expert opinions. Most courts will review only what is in that appeal file later, so build it carefully. For private policies, your state may allow additional evidence later, but it is still smart to present a full record as early as you can.
Common roadblocks
- Paper reviews by insurance doctors who never meet you
- Surveillance or social media clips taken out of context
- Job descriptions that ignore real-world duties
- Policy terms that quietly change the definition of disability after 24 months
Answer these with detailed medical support, accurate job descriptions, and statements from people who see your limits day to day.
Deadlines matter
Every policy has time limits for filing and appealing. ERISA plans often give you 180 days to appeal a denial. Miss a deadline and you may lose your rights. Mark dates on a calendar as soon as you receive any letter.
Be kind to yourself
You did not choose this. Healing takes time. Ask your doctor for clear restrictions in writing. Tell your family what you need. Keep a simple journal of symptoms, flares, and side effects. That record helps your care and your claim.
If you want guidance about your specific situation, you can reach the Law Offices of Eric A. Shore at 1800cantwork.com or 1-800-CANT-WORK.
