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Assessments Insurers Use In Approving Long-Term Disability Benefits

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Filing for long-term disability (LTD) benefits is often a time-consuming and confusing process. Meeting insurer qualifications is part of the process. Anytime you deal with LTD insurers, there will be assessments used to classify your level of disability. The following details some of these and other terms you may hear that are used to categorize your condition.

Activities of Daily Living (ADLs)

When applying for long-term disability benefits, the insurer will thoroughly review your medical records for details about your condition and how it is likely to impact your ability to work or perform other tasks in day to day life. In categorizing the type of disability you have and the severity of your condition, they will consider how it impacts Activities of Daily Living (ADLs). According to the National Institutes of Health (NIH), there are six basic ADLs:

  • Ambulating: This describes your ability to move and to walk from one place to another.
  • Feeding: This describes your ability to eat and feed yourself.
  • Dressing: This pertains to your ability to cloth yourself as well as to choose the appropriate attire.
  • Personal hygiene: This describes your ability to take care of grooming tasks, such as bathing, washing your hair, and trimming your nails.
  • Continence: This pertains to your ability to control bowel and bladder functions.
  • Toileting: This describes your ability to use the toilet appropriately and to clean yourself after.

These six basic ADLs are fundamental in reviewing your long-term disability claim. There are additional ADLs insurers may consider, depending on your particular job or skills. They pertain to performing more complex tasks as well as those that may be pertinent in your chosen career field.

Other Terms and Assessment UsedIn Categorizing Long-Term Disabilities

There are other important assessments and general terms insurers use in classifying long-term disabilities. These are described in your policy documents. Under the Employee Retirement Income Security Act of 1974 (ERISA), your employer is required to provide these to you at your request and free of charge. Those to pay close attention to include:

  • Functional Capacity Exam: These are tests used to determine how well you perform simple tasks, such as sitting, standing, or walking. They are used in deciding whether you can return to work.
  • Residual Functional Capacity (RFC): This is the level at which your condition may allow you to perform certain types of jobs. Categories range from sedentary to heavy, which means you can lift up to 100 pounds or more.
  • Pre-Existing Condition and Exclusionary Period: If your long-term disabilities are caused by pre-existing conditions, you will likely be excluded from LTD coverage for a certain period of time.
  • Recurrent Disability: This is when you suffer ongoing disabilities that permit you to return to work periodically and are not subject to new waiting periods.

Let Us Help You Today

Assessments used by insurers have a major impact on your claim. To protect your rights to LTD benefits, reach out to Farrell Disability Law. Contact our Jacksonville long-term disability attorney to request a consultation in our office today.

https://www.mydisabilitylaw.com/six-things-you-need-to-know-about-employer-provided-long-term-disability-benefits/

Farrell Disability Law is located in Jacksonville, FL and serves clients throughout Florida, including Jacksonville Beach, Jacksonville, Atlantic Beach, Orange Park, Doctors Inlet, Neptune Beach, Callahan, Bryceville, Middleburg, Fernandina Beach, Clay County, Duval County and Nassau County.
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