In understanding your LTD policy and the application process, it helps to start at the beginning, with the definitions of the two different types of disability that are covered in your policy:
This category is for individuals who are disabled and unable to perform any of their regular duties at their own current position but may be able to work in a different occupation.
This category is for individuals who are disabled and are unable to perform the regular duties of any occupation for which they are reasonably suited.
Many policies will initially categorize you as Own Occupation for a period of 24 months. At the end of your Own Occupation coverage, there will be an assessment to see whether you are eligible to continue receiving LTD benefits and thus moved into the Any Occupation category. If you are ineligible because you do not meet the definition or if you do not provide proper medical documentation in support of your claim, your benefits may be discontinued.
In addition to the types of coverage you are entitled to, there are certain clauses within your LTD policy you should pay special attention to:
In many LTD policies, there may be clauses which exclude or restrict you from receiving benefits if you have a pre-existing condition. This is often included in policies in order to protect the company from a high claim payout. Typically, pre-existing conditions become an issue if a disability occurs a short time after coverage begins. The insurer may then investigate to see whether your entitlement to benefits is excluded.
There is often a list of exclusions and limitations within your LTD policy. If any condition applies to you, you may not be eligible for benefits.
For example, some common exclusions are self-inflicted injuries such as substance abuse or self-harm.
This is the period of time between the onset of your disability and the time you are eligible for benefits. Once this period is satisfied, you will be eligible to receive your benefits at the end of the following month.
For example, if it states in your policy that there is a 90-day waiting period, this means you are four (4) months away from receiving your benefits.