Who Qualifies for Long-Term Disability Benefits?

Individuals who sustain rather severe injuries often qualify for long-term disability benefits. These benefits may come through an insurance provider paid for by an employer or privately out of pocket. Additionally, individuals may qualify for Social Security disability benefits that apply long-term. Here, we want to discuss who qualifies for long-term disability benefits in California.

There Are Various Types of Long-Term Disability Insurance

In working to understand long-term disability benefits, we have to recognize that there are various types, including both private insurance policies as well as government-run public insurance policies. 

Long-term disability insurance helps individuals who need coverage over an extended period of time. In some cases, this care takes place at a facility, but there are times when long-term care can happen at home. Typically, long-term disability policies help reimburse individuals for a daily amount of necessary help that they need, including:

• Bathing 
• Dressing
• Using the restroom
• Eating
• Help with medications
• Wound dressing
• Getting into and out of bed

This is only a brief list of the daily needs that long-term disability benefits can help with. Some of the areas where this long-term care can occur include rehabilitation facilities, hospice care, assisted living facilities, nursing homes, in-home care, memory in Alzheimer’s care facilities, and more.

Private Long-Term Care Insurance

In order to qualify for a private long-term disability insurance plan, an individual will have to have purchased and paid premiums on a plan. There are various insurance carriers around the country that offer these types of services. Additionally, an individual would have to have a medical condition that qualifies them for long-term disability under the insurance policy language. Finally, an individual would have to file a claim and have the claim accepted before the care can begin.

There are some employers that offer long-term disability benefits to employees, and this would be covered through their Employer Retirement Income Security Act (ERISA). 

In order to qualify for long-term disability under either a private insurance plan or an employer insurance plan, individuals must meet the disability requirements listed inside of the policy. Some conditions that could qualify individuals for long-term disability include asthma, carpal tunnel syndrome, chronic fatigue disorder, depression, epilepsy, heart disease, HIV/aids, lupus, lung disease, various types of cancers, post-traumatic stress disorder, strokes, and more.

Government Long-term Care (Social Security Disability Insurance)

Individuals may also qualify for Social Security Disability Insurance (SSDI) benefits. In order to qualify for SSDI, individuals must have worked in jobs covered by Social Security and also have a medical condition that meets the Social Security Administration’s strict definition of a disability.

In order to qualify for these benefits, the following must be true:

• An individual cannot work or engage in any substantial gainful activity because of their medical condition.
• An individual cannot do the work they previously did or adjust to other types of work because of their medical condition.
• The medical condition or disability has already lasted or is expected to last for at least one year or result in death.

Working With a Lawyer

If you or somebody you care about thanks you have sustained an injury that will lead to a long-term disability, you need to reach out to a skilled attorney in order to determine what type of benefits you qualify for.