Top Questions to Ask About Your Long-Term Disability Insurance Policy

Long-term disability insurance can be a financial lifeline for individuals unable to work due to illness or injury. However, navigating these policies can feel overwhelming. Understanding your coverage, claim process, and potential pitfalls is critical to protecting your benefits. Here are seven essential questions to ask about your long-term disability insurance policy, with insights from Bartolic Law’s extensive experience in resolving complex disability claims.

What Does My Policy Cover?

Different policies offer different definitions of “disability.” Some only cover disabilities that prevent you from performing your own job (“own occupation”), while others require that you’re unable to perform any occupation. Review whether your policy covers partial disabilities or only total disabilities. For example, if you’re a surgeon and can no longer practice due to a hand injury but can take on a desk job, the policy’s definition of disability could determine whether you qualify for benefits.

What Are the Waiting and Benefit Periods?

Most policies have an elimination period (waiting period) before benefits begin—commonly 90 to 180 days after your disability starts. It’s important to understand this timeline, as delays in filing can result in lost benefits. Additionally, confirm the duration of approved benefits. Some policies offer coverage only for a few years, while others continue payments until retirement age.

Are There Limitations or Exclusions?

Many individuals are caught off guard by policy exclusions. For example, some policies impose a 24-month cap on benefits for mental health conditions or self-reported symptoms like chronic pain. At Bartolic Law, we’ve helped clients challenge the improper application of these limitations. If you have a condition like fibromyalgia or depression secondary to another illness, insurers may try to terminate benefits early, even when the disabling cause is physical.

Does My Policy Have Pre-Existing Condition Exclusions?

Pre-existing condition clauses can bar claims related to illnesses or injuries you sought treatment for before enrolling in coverage. These exclusions can be broadly applied—even symptoms that went undiagnosed could disqualify a claim. For instance, an executive we helped had symptoms later linked to ALS, which the insurer incorrectly tried to classify as pre-existing. We successfully argued the exclusion didn’t apply in that case, leading to full benefits.

What Documentation Does the Insurer Require?

Insurers heavily scrutinize claims, often denying them for insufficient evidence. Assemble comprehensive medical records, physician opinions, test results, and additional evidence, such as video documentation of how your disability impacts daily activities. Bartolic Law emphasizes crafting appeals that leave no room for misinterpretation. For example, we’ve used detailed visual evidence alongside medical records to humanize our clients and strengthen their claims.

How Does My Policy Handle Offsets?

Many policies contain provisions for “offsets,” which reduce your benefit amount based on other income sources like Social Security Disability Insurance (SSDI) or workers’ compensation. Knowing how these offsets apply can help you plan financially. For example, an insurance company might calculate overpayment if you receive SSDI and then deduct that amount from future benefits.

What Are My Options If My Claim Is Denied?

Denials are common, but they’re not the end of the road. Under ERISA regulations, you have 180 days to appeal. This is your only chance to present comprehensive evidence before litigation, making it critical to seek legal help early. At Bartolic Law, we manage the entire appeal process, crafting persuasive arguments to overturn denials. Whether it’s disputing misapplications of policy definitions or challenging biased medical reviews, our innovative approach levels the playing field.

Take Control of Your Policy

Understanding your long-term disability insurance is your first line of defense against denials. At Bartolic Law, we combine compassion, transparency, and innovation to help clients secure the benefits they deserve. If you have questions about your policy or need assistance with a denied claim, contact us for a consultation. Together, we can help protect your financial future while you focus on your recovery.