What Conditions Automatically Qualify You as Disabled?

If you’re living with a serious, chronic illness, it’s likely that someone has said, “You have that diagnosis?! You’ll definitely get disability benefits.” While you may appreciate your loved one’s confidence, you may question the accuracy of their statement. Disability insurance companies, like UNUM, Lincoln Financial, and The Hartford, are notorious for denying even legitimate claims for benefits.

As a general rule, insurers look for any possible reason to deny, delay, or undervalue disability insurance claims. However, even though it’s rare, some private disability insurance policies automatically qualify people with certain conditions for benefits. This is a significant advantage and can streamline your long-term disability (LTD) claim.

What Does It Mean to Automatically Qualify for LTD Benefits?

When most people talk about automatic qualification for disability benefits, they’re referring to Social Security Administration rules where people with very specific medical conditions immediately qualify for benefits under a compassionate allowance or the Listings of Impairment. These rules do not apply to disability insurance companies.

However, some disability insurance policies do include their own lists of conditions that automatically qualify you for LTD or other benefits. Conditions that may automatically qualify the policyholder for disability benefits include:

  • Advanced cancer
  • Organ transplantation
  • Blindness
  • Deafness
  • Alzheimer’s disease
  • ALS
  • Severe heart conditions
  • Paralysis and spinal cord injuries

If your condition is listed, you do not have to prove that you are disabled. Instead, you only must show that you have the diagnosis listed in the plan document.

For example, suppose your doctors diagnose you with stage IV lung adenocarcinoma. Your disability insurance lawyer reviews your plan and discovers that advanced stage cancers automatically qualify for benefits. Instead of having to prove that you have a medical diagnosis, suffer from specific symptoms, and cannot maintain employment, you only have to show that you have a diagnosis that is on the “automatic qualification” list.

How Do I Prove That I Automatically Qualify for Disability Benefits?

To be clear, merely filling out a disability insurance application and reporting that you have cancer will not result in an approved claim. Insurance companies are highly skeptical of all claimants, but especially those with serious and potentially expensive claims.

You will need to provide extensive medical records, including diagnostic studies and other objective data, to show that your diagnosis meets the exact requirements of the plan’s automatic qualification list.

However, even if your condition may qualify you for disability benefits automatically, the insurer may still argue that you’re ineligible. You must know exactly what your disability plan requires you to show in order to qualify for benefits. The adjuster may cherry-pick your medical records or use a consulting physician who believes that your condition does not meet the precise requirements of the plan. In these cases, you’ll need an experienced disability insurance lawyer to fight for you. Depending on your evidence, you may qualify for your disability benefits on appeal.

Further, depending on the condition, the insurer may require regular updates on your condition as time goes on. If the condition improves, the insurer may terminate your long-term disability benefits.  You should never misrepresent your condition, since it may disqualify you from receiving benefits and could expose you to both civil and criminal liability.

However, if the adjuster terminates your benefits and you believe that you still are disabled, you should immediately contact Bryant Legal Group – you may have appeal rights.


What if I Don’t “Automatically” Qualify for Disability Insurance Benefits?

Just because your condition doesn’t meet the specific criteria of your disability insurance plan’s automatic qualification list, that doesn’t mean you’re ineligible for long-term disability benefits. Instead, you’ll need to prove that you meet your plan’s definition of disability. This will usually require that you provide evidence demonstrating a loss of function that prevents you from continuing to perform your own occupation or any occupation.

What constitutes a “disability” can vary from plan to plan, but you typically must show that you cannot perform your existing job or any other job within the economy. This may require evidence from your doctors, vocational experts, and other sources.

RELATED: Why Vocational Experts Can Make a Difference in LTD Claims

Contact a Qualified Chicago Private Disability Attorney Today

Here at Bryant Legal Group, our attorneys have spent decades representing clients in a range of private disability insurance disputes.  We are committed to providing personalized advocacy. We work closely with clients throughout the submission, appeals, and litigation processes to ensure that they are apprised of new developments in the case.

Call (312) 561-3010 or complete our online form today to connect with an experienced Chicago private disability attorney at Bryant Legal Group.  We look forward to evaluating your dispute and helping you move forward with your claims.

The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

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