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.
Why Thorough Medical Documentation Is Essential for Long-Term Disability Claims
Comprehensive medical records are essential for these conditions, serving as the cornerstone of your claim. These documents serve as the foundation for your claim, showing:
- The severity of your condition,
- The treatments you’ve undergone, and
- How the condition impairs your ability to work.
Without thorough documentation, insurance companies may deny claims or argue that your condition does not meet the policy’s definition of disability.
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. So what illness qualifies for long-term disability? 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.
What Other Medical Conditions Qualify for Long-Term Disability?
Depending on your policy’s specific terms, other conditions could also qualify for long-term disability benefits, including the following.
Chronic Pain and Fatigue Syndromes
- Fibromyalgia—causes widespread pain, fatigue, and cognitive issues, which can make maintaining a full-time job challenging; and
- Chronic Fatigue Syndrome (CFS)—persistent, debilitating fatigue not alleviated by rest often prevents sufferers from fulfilling occupational duties.
Endocrine Disorders
- Hypothyroidism—severe cases may result in fatigue, depression, and cognitive impairment, making work impossible; and
- Cushing’s Syndrome—this hormonal imbalance can cause weight gain, high blood pressure, and emotional instability.
Kidney and Liver Diseases
- Chronic Kidney Disease (CKD)—advanced stages of CKD often require dialysis, significantly impairing an individual’s ability to maintain gainful employment; and
- Cirrhosis—symptoms like fatigue and confusion often prevent those with liver failure from working.
Rare or Complex Conditions
- Ehlers-Danlos Syndrome—this group of connective tissue disorders causes joint dislocations, chronic pain, and fatigue; and
- Postural Orthostatic Tachycardia Syndrome (POTS)—this nervous system disorder can result in dizziness, fainting, and severe fatigue.
These conditions highlight the broad range of health issues that can interfere with your ability to work and qualify for long-term disability benefits.
If your condition significantly impairs your daily functioning or job performance, it’s worth reviewing your policy to determine eligibility. Our experienced long-term disability attorney can help you understand your rights and gather the necessary evidence to support your claim.
Medical Illnesses and Disorders That May Qualify for Long-Term Disability
| Condition Type | Examples | Impact on Work |
| Musculoskeletal Disorders | Arthritis, back pain, fibromyalgia | Chronic pain, limited mobility, and fatigue hinder physical tasks or prolonged sitting/standing. |
| Neurological Disorders | Parkinson’s disease, multiple sclerosis, epilepsy, migraines | Impaired motor functions, cognitive issues, or seizure activity can interfere with job performance. |
| Mental Health Conditions | Bipolar disorder, PTSD, major depressive disorder | Severe mood swings, anxiety, or inability to concentrate often disrupt workplace interactions and duties. |
| Cardiovascular Conditions | Heart disease, stroke, chronic hypertension | Fatigue, physical limitations, and recovery time can prevent consistent employment. |
| Respiratory Conditions | COPD, asthma, pulmonary fibrosis | Difficulty breathing may limit physical exertion and create safety risks in certain occupations. |
| Autoimmune Diseases | Lupus, rheumatoid arthritis, Type 1 diabetes | Flare-ups and complications may cause absenteeism or render physical work impossible. |
| Cancer (Various Types) | Breast cancer, leukemia, lymphoma | Treatments like chemotherapy often result in fatigue, nausea, and immune suppression, making work infeasible. |
| Chronic Pain/Fatigue Syndromes | Fibromyalgia, chronic fatigue syndrome | Persistent pain and exhaustion can prevent regular attendance and productivity. |
| Rare or Complex Disorders | Ehlers-Danlos Syndrome, POTS | Symptoms like joint instability or fainting spells may severely restrict occupational duties. |
| Endocrine Disorders | Severe hypothyroidism, Cushing’s Syndrome | Causes cognitive impairments, fatigue, and hormonal imbalances that interfere with occupational tasks. |
| Kidney and Liver Diseases | Chronic kidney disease (CKD), cirrhosis | Symptoms like fatigue, cognitive issues, and treatment needs make consistent employment difficult. |
| Vision and Hearing Loss | Total blindness or deafness | Severely limits the communication and physical coordination required in many work settings. |
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.
Common Challenges in Applying for Long-Term Disability Benefits
Filing for long-term disability benefits is rarely straightforward. Many applicants encounter obstacles that can complicate the claims process.
Policy Exclusions
Insurance policies often include clauses that limit or exclude coverage for certain conditions. Understanding these exclusions can be daunting without professional guidance.
Proving Severity
Insurers frequently challenge the severity of a claimant’s condition, requiring extensive medical documentation to prove that the disability is significant enough to prevent gainful employment. This often involves securing expert opinions and diagnostic tests, which can be time-consuming and costly.
Pre-Existing Condition Denials
Insurers may deny claims by attributing symptoms to a pre-existing condition even when a condition worsens due to new circumstances. Successfully challenging such denials requires clearly demonstrating how the condition was aggravated or changed over time.
Delays and Denials
Insurance companies often delay processing or denying claims outright, citing insufficient evidence or technical policy violations. These tactics can prolong financial strain and create unnecessary stress for applicants.
Overcoming these challenges typically requires a proactive approach, detailed documentation, and the support of an experienced long-term disability attorney who understands the complexities of the claims process.
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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