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How to show continuous disability during an elimination period

On Behalf of | Sep 20, 2023 | Erisa

Most long-term disability (LTD) policies have an elimination period (EP) – typically three to six months from the start of your disability – where no benefits are paid. 

Once the elimination period passes, you can generally qualify for a period of short-term disability (STD) benefits before you transition to your long-term benefits. Unfortunately, there’s a trap that’s often hidden in the fine print: You need to show that your disability was continuous for the entire EP and STD period, first.

Why is this so hard?

This is a cost-control measure put in place by insurance companies, and they’re not hesitant to use it to their advantage. If there’s inadequate documentation in your medical records to show in detail how you continue to be disabled throughout the EP and STD periods, your claim can be denied.

To best support your disability claim, you should:

  • Make certain that you continue to visit your primary care physician and any specialists you have throughout the EP/STD periods, even if your condition is unchanged. That allows for ongoing documentation of your condition.
  • Make sure that you do any follow-up testing prescribed by your doctor.  The follow-up tests, such as blood tests and imaging studies may lend objective evidence to your claim.
  • Keep records of how often your condition flares up or how it limits you, especially if it is variable. For example, document pain flares, including their frequency and severity.  Email or provide your contemporaneous logs to your physician so that they are included in your medical file.

If you’ve received a long-term disability claim denial based on the idea that you haven’t been continuously disabled for the prescribed period, you have every right to file an appeal. Legal guidance may be important to your success.