What Conditions Qualify for Long-term Disability in South Carolina

What Conditions Qualify for Long-term Disability in South Carolina

When life throws you a curveball with a disabling condition, wondering who will pay your bills should not be a priority. Your finances should not precede your recovery. Often, when a disabling condition hits your household, finances become an unavoidable cause of concern and anxiety. However, if you have a long-term disability policy, you can rest easy knowing you may be entitled to benefits, which can help ease the financial burden during your recovery.

How Do I Know I Qualify for Long-term Disability?

To qualify for long-term disability in South Carolina, you must first have a long-term disability insurance policy. Your employer may provide a policy, or you could purchase one independently. Most policies require that you be unable to perform the material duties of your occupation due to an illness or injury. Some policies may also require you to be unable to perform gainful employment. Your condition must also meet the definition of a “disability.”

This definition defines the terms you must satisfy for your condition to qualify as a disability, according to your insurance company. You must thoroughly understand this definition and the requirements of your policy to ensure that you submit all necessary evidence.

What Medical Conditions Qualify for Long-term Disability?

While some people think that injuries have to result from a severe accident to qualify, in reality, an accident does not need to happen. A wide range of medical conditions could qualify an applicant for disability coverage under their insurance policy. The most common conditions include musculoskeletal disorders, arthritis, back pain, and chronic pain.

Below is a list of other qualifying conditions that may be severe enough by disability insurance companies to qualify a claimant for long-term disability:

  • Mental health conditions such as PTSD, bipolar disorder, and psychosis;
  • Various cancers at stage 2 or 3 levels and melanoma, lymphoma, and leukemia;
  • Cardiovascular disorders such as heart disease and stroke;
  • Autoimmune disorders such as rheumatoid arthritis, lupus, and type 1 diabetes;
  • Neurological conditions such as multiple sclerosis, Parkinson’s disease, epilepsy, and carpal tunnel;
  • Respiratory disorders such as asthma and COPD; and
  • A digestive disorder like Crohn’s disease, ulcerative colitis, and irritable bowel syndrome.

The list is not exhaustive; other conditions may qualify for long-term disability. There are so many that it would be almost impossible to list them all. Many of the above conditions may overlap in category, and qualification for long-term disability is dependent on the terms of your specific policy. 

Even if a condition is not disabling, sometimes the necessary medical treatment can significantly interfere with an individual’s ability to obtain and maintain gainful employment, making such individuals eligible for disability insurance benefits. Or, your disability status may be due to a combination of medical conditions and injuries that leave you unable to work.

On the other hand, some conditions are so obviously disabling they may automatically qualify for approval under your insurance policy. If you have one of these conditions, you will not need to demonstrate the injury’s extent, nature, or impact. Automatically qualifying conditions usually include:

  • Amputation
  • Total deafness
  • Total blindness

Although your policy may have a list of conditions that automatically qualify, it will not contain a “master” list of every possible injury or disease that could qualify. 

It is also important to remember that many long-term disability policies come with limitations or exclusions for specific conditions. Some of the most common limitations and exclusions include the following:

  • Pre-existing conditions,
  • Mental health conditions,
  • Other illnesses and conditions with “self-reported” symptoms,
  • Alcohol and substance abuse, and
  • Workplace injuries.

If you were hurt on the job, any resulting disability should be covered by your workers’ compensation policy, not long-term disability insurance coverage.

How Do I File a Claim for Conditions that Qualify for Long-term Disability?

If you believe you meet the definition of disability in your policy, you will need to file a claim for long-term disability benefits with your insurance company. This typically involves providing medical evidence of your condition and demonstrating that you cannot work. The insurance company will review your claim and decide whether or not you qualify for benefits. 

The best way to determine whether a specific condition is covered is to have an experienced long-term disability lawyer review your insurance policy.

A Long-term Disability Attorney Can Help

While you can apply for benefits on your own, it can be beneficial to seek the assistance of a long-term disability attorney. Insurance companies can be difficult to work with, and it can be challenging to understand your policy’s requirements and the laws surrounding your claim. John Peace founded the Peace Law Firm in Greenville, South Carolina, in 2002. He doesn’t represent insurance companies or employers but is passionate about representing individuals like you. He has over 20 years of experience relating to personal injury claims. To request a consultation, please call 864-298-0500. 

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