What Long-Term Disability Insurance Is and Who Offers It

Long-term disability (LTD) insurance is a private insurance product that replaces part of your income if you cannot work for an extended period due to illness or injury. It is not a government program. In California, you typically obtain it through your employer, though self-employed people and individuals can purchase it directly from insurance companies.

The key difference from Social Security Disability Insurance (SSDI) is that LTD is a contract between you and an insurance company—your employer may pay the premium, you may pay it, or you may split the cost. SSDI is a federal program based on your work history and Social Security taxes. Many people have both, and they work together: LTD usually pays first, then SSDI may supplement it later.

California does not run its own long-term disability program. Instead, the state regulates private insurers and employers who offer LTD plans. If your employer offers a plan, you will find details in your employee handbook or benefits materials. If you do not have employer coverage, you can buy an individual policy from insurance companies that operate in California.

Key Takeaways

  • Long-term disability is sold by private insurance companies, usually through your employer, and requires you to submit a claim form and medical evidence within a set time window after your disability begins.
  • Your employer's human resources or benefits department holds the plan documents and claim forms; you cannot claim directly with the insurance company without going through them first.
  • The process process typically takes 30 to 90 days from the time you submit all required documents, and the insurer will request medical records from your doctor.
  • California law requires insurers to notify you in writing of approval or denial, and you have the right to appeal a denial within a specific timeframe listed in your plan documents.
  • If you do not have employer coverage, you can purchase an individual LTD policy, though premiums are higher and underwriting is stricter than group plans.

Step 1: Confirm You Have Long-Term Disability Coverage

Before you can explore, you need to know whether your employer offers a long-term disability plan. Check your employee handbook, benefits guide, or the benefits section of your company's intranet. If you received materials when you were hired, look for a document labeled "Summary Plan Description" or "Plan Document." These explain what is covered, how much you receive, and how to file a claim.

If you cannot find the documents, contact your human resources (HR) or benefits department directly. Ask them: "Do we have a long-term disability plan?" and "If yes, who is the insurance carrier?" They will give you the plan name and the insurer's name. Write down both. You will need this information to file your claim.

If your employer does not offer LTD, you have two options: purchase an individual policy from an insurance company, or explore whether you may be may be able to access for SSDI through Social Security. An individual policy will cost more and take longer to underwrite, but it provides coverage once approved.

Step 2: Gather Your Medical Documentation

The insurance company will not take your word that you cannot work. You must provide medical evidence from a licensed healthcare provider. Start by scheduling an appointment with your doctor—the one who is treating your condition or who knows your medical history best. Tell them you are filing a disability claim and ask them to document your condition, your symptoms, and any functional limitations that prevent you from working.

Collect the following documents before you submit your claim:

  • A detailed letter from your doctor describing your diagnosis, when it began, current treatment, and why you cannot perform your job duties.
  • Recent medical records, test results, or imaging reports that support the diagnosis.
  • A list of medications you are taking and any side effects that affect your ability to work.
  • If you see a specialist (cardiologist, neurologist, psychiatrist), ask for a statement from them as well.
  • Records from any hospitalizations, surgeries, or emergency room visits related to your condition.

Do not wait for the insurance company to request these. Gather them now and keep copies for your records. The more complete your medical file, the faster the insurer can make a decision.

Step 3: Obtain and Complete the Claim Form

Your HR or benefits department will provide the long-term disability claim form. This is usually called a "Claim for Benefits" or "Disability Claim Form." The form asks for your personal information, employment details, the date your disability began, and a description of why you cannot work.

Fill out every section completely and accurately. If a question does not explore to you, write "N/A" rather than leaving it blank. The insurer uses incomplete forms as a reason to delay or deny claims. Pay special attention to the date your disability began—this is the date you stopped working or the date your condition made work impossible, not the date you decided to file a claim.

You will also need to authorize the release of your medical records. The form includes a signature line for this authorization. Without it, the insurer cannot contact your doctor or obtain your medical records, and your claim will stall.

Step 4: Submit Your Claim to Your Employer's Benefits Department

Do not send your claim directly to the insurance company. Send it to your employer's HR or benefits department, along with all medical documentation. Ask for a receipt or confirmation that they received it, and note the date you submitted it. Keep a copy of everything you send.

Your employer's benefits department will forward your claim to the insurance company on your behalf. This is standard procedure for group plans. The insurer will then contact you or your doctor to request additional information if needed.

If you are no longer employed (because your disability forced you to leave), contact the insurance company directly. Your plan documents will list a claims phone number and mailing address. Ask whether you can submit your claim after leaving employment—most plans allow this within a set window, often 90 days from the date your disability began.

Step 5: Respond to Requests for Additional Information

After you submit your claim, the insurance company will review it. They may request additional medical records, ask your doctor to complete a detailed questionnaire about your functional capacity, or ask you to undergo an independent medical examination (IME) at their expense. Respond to every request promptly—delays in providing information can delay approval.

If the insurer requests an IME, you have the right to have your own doctor present. You also have the right to receive a copy of the IME report. Ask for it in writing after the examination is complete.

The insurer may also ask you to provide proof that you are not working elsewhere. This might include recent pay stubs, a letter from your employer confirming your leave status, or a signed statement from you. Answer honestly and completely.

Step 6: Receive the Decision and Understand Your Options if Denied

The insurance company will send you a written decision within 30 to 90 days of receiving your complete claim. The letter will state whether your claim is approved, denied, or approved with conditions (such as a waiting period before benefits begin).

If approved, the letter will explain when your benefits start, how much you will receive each month, and how long they will last. Long-term disability benefits in California typically replace 50 to 70 percent of your pre-disability income, though this varies by plan. The letter will also explain whether your benefits will be reduced if you receive SSDI or workers' compensation.

If denied, the letter must explain the reason in detail. Common reasons include insufficient medical evidence, a pre-existing condition exclusion, or a information that you can still perform some type of work. You have the right to appeal. Your plan documents will state the appeal important date—usually 30 to 60 days from the denial letter. To appeal, submit a written request to the insurance company along with any new medical evidence or documentation that addresses the reason for denial.

Frequently Asked Questions

How long does it take to get approved for long-term disability in California?

Most claims take 30 to 90 days from the date you submit a complete process with all medical records. If the insurer requests additional information or an independent medical exam, it may take longer. Some claims are approved in two to three weeks if the medical evidence is clear and straightforward.

Can I work part-time while receiving long-term disability benefits?

This depends on your specific plan. Some plans allow part-time work or limited earnings without reducing benefits; others reduce or eliminate benefits if you earn any income. Check your plan documents or ask your HR department before you return to any work.

What happens if my employer goes out of business or cancels the plan?

If you are already receiving benefits, California law generally requires the insurer to continue paying you. If the plan is cancelled before you file a claim, you may lose coverage. Ask your HR department when ready if the plan is being cancelled, and file a claim right away if you are disabled.

Do I need a lawyer to file a long-term disability claim?

You do not need a lawyer to file an initial claim. However, if your claim is denied and you plan to appeal, consulting with a disability attorney can help. Many attorneys work on contingency, meaning they take a percentage of your back pay if you win the appeal.

Can I file for SSDI while waiting for my long-term disability decision?

Yes. SSDI and long-term disability are separate programs with separate applications. You can file for both at the same time. If you are approved for both, SSDI will typically pay after your LTD benefits, or your LTD may be reduced by the SSDI amount, depending on your plan.