Helping People With Disabilities Nationwide

How does my Short Term/Long Term Disability carrier decide if I am disabled?

On Behalf of | Sep 12, 2022 | WC - Long-Term Disability |

All Short Term and Long Term Disability benefits are governed by the Policy language. Whether you have The Hartford, Lincoln Financial, CIGNA, etc., a Policy will exist that governs the definition of disability as well as the length and the amount of your benefits. You will want to ask for a copy of this Policy from your Employer or from your STD/LTD carrier.

Before receiving LTD benefits, you will receive STD benefits which typically last 3-6 months depending on the Policy language. Your STD carrier will review your medical records and determine whether your diagnoses, treatment, and restrictions prevent you from performing the essential duties of your “own occupation.” If the carrier decides you can no longer work in your own occupation, you will be given STD benefits.

What happens after short-term benefits end?

Once your STD benefits end, you can apply for LTD benefits or your carrier will roll your STD benefits over into LTD benefits without you having to apply. You will need to communicate with your LTD carrier about what steps you need to take.

Whether you apply for LTD or you are rolled over into LTD, the same “own occupation” standard is used for the first two years that LTD benefits are payable. In other words, if your carrier determines that you cannot perform the essential duties of your “own occupation,” you can collect LTD benefits for two years.

Long-term benefits after two years

Once two years is up, the definition of disability changes to “any occupation.” LTD will now look at your diagnoses, treatment, and restrictions to see whether it prevents you from performing any occupation. For example, if you worked as a manual laborer for a construction company before you became disabled, LTD will see if there is a desk job that you do that is within your restrictions. If they determine another job exists, they will deny your LTD benefits.

Before denying your LTD benefits, they will look at your age, education, and experience to determine whether you have the skills and/or abilities to do another job. Unfortunately, most LTD denials happen around that two-year mark and base the denial on the shift from “own occupation” to “any occupation.” If, however, you successfully appeal this denial, you can receive LTD benefits for as long as your disability remains.


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