To apply for long-term disability through your employer, start by requesting your plan’s Summary Plan Description from HR, then assemble a complete claim package: your employee statement, an attending physician’s statement from your treating doctor, an employer’s statement completed by HR, and your supporting medical records. Submit the package to the insurance carrier with proof of delivery and keep copies of everything. Most employer-sponsored LTD plans are governed by a federal law called ERISA, which gives you specific rights during the process and sets deadlines the insurer must follow. The steps look simple on paper. The details are where claims are won or lost.
Start With the Summary Plan Description
Before you fill out a single form, get the Summary Plan Description (SPD) from your human resources department. The SPD explains in plain language what your plan covers, how benefits are calculated, and what you need to do to file. Your plan administrator must provide a copy within 90 days of your becoming a participant.1Office of the Law Revision Counsel. 29 USC 1024 – Filing With Secretary and Furnishing Information to Participants and Beneficiaries Request it immediately if you don’t have one. Everything else flows from what this document says.
How Your Plan Defines Disability
The most important provision in the SPD is the definition of “disability.” Some plans use an “own occupation” standard, meaning you qualify if you can’t perform the specific duties of your current job. Others use a stricter “any occupation” standard, meaning you only qualify if you can’t perform any job you’d reasonably be suited for based on your education and experience. Many plans start with the own-occupation standard and switch to any-occupation after a set period, often 24 months. Know which standard applies and when it changes. This determines what your doctor needs to document.
The Elimination Period
Every LTD plan has an elimination period, a waiting period between when your disability begins and when benefits start. The most common are 90 or 180 days. Think of it as a deductible measured in time. If your employer also offers short-term disability coverage, STD benefits often bridge this gap, and many plans require you to exhaust STD before LTD kicks in.
Pre-Existing Condition Exclusions
Most employer LTD plans exclude conditions that existed before your coverage began. The structure typically involves a look-back period (often 3 to 12 months before your coverage start date) and an exclusion period (commonly 12 months after coverage begins). If you were treated for a condition during the look-back window, a disability caused by that condition won’t be covered during the exclusion period. After that, the condition becomes covered like anything else. Filing during the exclusion window for a pre-existing condition is one of the most common reasons claims get denied outright, so read these dates carefully.
Build the Claim Package
An LTD claim is a package deal. You can get the forms from HR or the insurer’s online portal. Three separate sections are completed by three different parties, and you add your supporting medical records.
Your Employee Statement
This is your portion. You’ll provide personal information, your job title, salary, and a detailed description of your daily work duties. Don’t gloss over the duties section. The insurer compares what your job requires against what your doctor says you can’t do, so a vague entry like “office work” won’t help you. Describe the physical and cognitive demands: how long you sit or stand, what you lift, how much sustained concentration is involved, how often you travel. Then describe your condition, how it limits your ability to work, and the date you stopped working.
Your Doctor’s Statement
Your treating physician completes the attending physician’s statement. It asks for your diagnosis, when symptoms started, treatments you’ve had, and objective findings like lab results and imaging. The critical part is where your doctor describes your specific functional limitations. Share the plan’s definition of disability with your doctor before they fill it out. A physician who understands the standard the insurer will apply can speak directly to it, which is far more effective than generic notes about your condition.
The Employer’s Statement
HR completes this section to verify your employment status, job title, work schedule, and salary history. You don’t fill it out, but don’t assume it goes in automatically. Follow up with HR to confirm it has been sent. The carrier uses this to confirm eligibility and calculate your benefit, which typically ranges from 50% to 80% of pre-disability earnings up to a plan maximum.
Supporting Medical Records
Beyond the physician’s statement, gather records from every doctor, therapist, and specialist who has treated you. Include hospital discharge summaries, imaging reports, and lab work. The adjuster looks for consistency across your records; gaps or contradictions between providers give the insurer reasons to question the claim. If your condition involves physical limitations, consider getting a Functional Capacity Evaluation before you file. For cognitive conditions, a neuropsychological evaluation serves a similar role. These produce objective data that is harder to dismiss than a narrative description alone.
Submit the Package and Keep Proof
Before anything leaves your hands, photocopy or scan the complete package. If the insurer later says a document was never received, your copy is the only proof of what you submitted and when.
If you mail the application, use certified mail with a return receipt. If you use an online portal, save the confirmation email and reference number. The submission date starts the insurer’s decision clock, and you want it documented.
Submit a complete package the first time. If any section is missing, the insurer will request it and the timeline resets while you wait. Confirm that your statement, the physician’s statement, and the employer’s statement are all included along with your supporting records before you send.
What Happens After You File
Once the insurer has your complete claim, federal regulations give it 45 days to make an initial decision. That is often just the start. The insurer can take up to two additional 30-day extensions if it says circumstances beyond its control require more time, and each extension requires written notice before the current period expires, with an explanation of what’s unresolved and what more it needs.2eCFR. 29 CFR 2560.503-1 – Claims Procedure If the insurer asks you for more information, you get at least 45 days to respond, and the clock pauses while you do.
During the review, a claims adjuster may contact you or your doctor’s office to clarify something in the file. Respond quickly and completely. The insurer may also require you to attend an Independent Medical Examination with a doctor it selects and pays for. Refusing to attend can result in denial.3U.S. Department of Labor. Benefit Claims Procedure Regulation FAQs At the IME, describe your symptoms and limitations the same way you’ve described them to your own doctor. Inconsistencies between what you tell the examiner and what’s in your medical records are exactly what adjusters look for.
If Your Claim Is Denied
A denial isn’t the end, but how you respond determines everything that follows. The insurer must send a written denial letter stating the reasons for the denial, the plan provisions it relied on, what additional information could support your claim, and a full description of your appeal rights. For disability claims, the letter must also explain why the insurer disagreed with your treating doctor and identify any internal guidelines it used.2eCFR. 29 CFR 2560.503-1 – Claims Procedure Read it closely. It is a roadmap for the appeal.
You have at least 180 days from receipt of the denial to file an internal appeal.2eCFR. 29 CFR 2560.503-1 – Claims Procedure That clock starts when the letter reaches you, not when it was dated. Six months sounds generous, but building a strong appeal takes time, especially if you need new specialist evaluations. Request copies of everything the insurer relied on; you’re entitled to those documents free of charge, and they tell you exactly what the adjuster was looking at.
Address every reason the insurer gave. If the denial cited insufficient objective evidence, add updated testing or a detailed functional assessment. If the IME physician disagreed with your treating doctor, get a rebuttal opinion. And treat this appeal as your trial, not a formality. If the insurer upholds the denial and you later sue, courts generally limit the case to the evidence that was already in the administrative record. New medical evidence, new testimony, new experts, typically none of that comes in. Every piece of support for your claim needs to be in the file before the insurer issues its final decision.
What Your Check Will Actually Look Like
An approved monthly benefit of 50% to 80% of your pre-disability earnings is a starting figure, not a take-home figure. Two things reduce it.
Offsets
Most LTD policies reduce your benefit dollar-for-dollar by amounts you receive from other sources. The most common offset is Social Security Disability Insurance. If your plan pays 60% and you’re also approved for SSDI, the insurer subtracts your SSDI payment from the LTD benefit. Some policies require you to apply for SSDI and will estimate and deduct an expected amount before you’ve even been approved. Workers’ compensation, state disability benefits, and pension income are other common offsets. Your SPD lists which income sources count.
Taxes
Whether your benefits are taxable depends on who paid the premiums. If your employer paid them and you didn’t include those payments as taxable income, your benefits are fully taxable as ordinary income.4Office of the Law Revision Counsel. 26 USC 105 – Amounts Received Under Accident and Health Plans If you paid with after-tax dollars, the benefits are tax-free. If costs were split, only the employer-funded portion is taxable. One trap: if you pay premiums through a cafeteria plan with pre-tax payroll deductions, the IRS treats those premiums as employer-paid, and your benefits are fully taxable.5Internal Revenue Service. Life Insurance and Disability Insurance Proceeds Check your pay stubs to see which applies.
LTD Doesn’t Protect Your Job or Your Health Insurance
Receiving LTD benefits does not, by itself, keep your job open or continue your group health plan. Job protection comes from separate laws.
The Family and Medical Leave Act provides eligible employees up to 12 weeks of unpaid, job-protected leave per year for a serious health condition and requires employers to maintain group health benefits during that leave.6U.S. Department of Labor. Family and Medical Leave (FMLA) FMLA typically runs concurrently with the LTD elimination period, and 12 weeks is only about three months. Most LTD claims last far longer.
The Americans with Disabilities Act may require additional leave as a reasonable accommodation after FMLA runs out, unless doing so would cause the employer undue hardship, and it includes the right to return to your position after accommodation leave.7U.S. Equal Employment Opportunity Commission. Employer-Provided Leave and the Americans with Disabilities Act If your approved leave is running out, raise it with HR directly rather than assuming a third-party LTD administrator is routing the question internally.
When employment ends or hours are cut because of disability, you become eligible for COBRA continuation of your employer health plan for 18 months. If the Social Security Administration finds you disabled within the first 60 days of COBRA coverage, you can get an 11-month extension to 29 months, with premiums of up to 150% of the normal cost during the extension.8U.S. Department of Labor. FAQs on COBRA Continuation Health Coverage for Workers You have to notify the plan administrator of the SSA determination within the timeframe your plan sets, which can’t be shorter than 60 days from when the determination is issued.9Centers for Medicare and Medicaid Services. COBRA Continuation Coverage Questions and Answers COBRA premiums are steep. A gap in coverage during a serious medical condition is worse.