What Long-Term Disability in New York Actually Covers

Long-term disability (LTD) in New York is an insurance benefit, not a government program. Your employer or union provides it as part of your benefits package. It replaces a portion of your income—typically 50 to 70 percent—if you become unable to work due to illness or injury for an extended period, usually longer than 90 days.

New York does not run a state-level long-term disability program. Instead, you claim through your employer's insurance carrier or your union's plan. The process, timeline, and required documents depend entirely on which carrier handles your employer's plan. Some common carriers in New York include Unum, MetLife, Cigna, and Hartford, but yours may be different.

Before you start, find your plan documents. Your employer's human resources or benefits department can tell you which carrier manages your LTD coverage and provide you with the plan summary and claim forms. If you no longer work there or cannot reach them, check any benefits paperwork you received when you were hired.

Key Takeaways

  • Long-term disability is provided by your employer's insurance carrier, not by New York State, and you must claim through that specific carrier.
  • You need your plan documents and the carrier's contact information from your employer's benefits department before you can start a claim.
  • Most carriers require a completed claim form, medical records from your doctor, and proof that you cannot perform your job duties.
  • The approval process typically takes 30 to 60 days, and the carrier will contact your doctor directly to verify your condition.
  • If your claim is denied, you have the right to appeal, and the appeal process is outlined in your plan documents.

Step 1: Locate Your Plan Documents and Carrier Information

Contact your employer's human resources or benefits department and ask for three things: the name of your long-term disability insurance carrier, your policy number, and a copy of the plan summary or summary of benefits and coverage. Write down the carrier's phone number and website. If you are no longer employed, ask if they will mail or email these documents to you.

If your employer will not provide this information, check any benefits materials you received when hired—enrollment forms, benefit guides, or welcome packets often list the carrier name. You can also call your employer's main phone line and ask to be transferred to benefits or payroll; they are required to provide this information to current and former employees.

Once you have the carrier's name, visit their website or call their claims line. Most carriers have a dedicated phone number for new disability claims. Write down this number and keep it handy—you will use it multiple times during the process.

Step 2: Gather Medical Documentation Before You File

Your doctor must document that you cannot work. Before you contact the carrier, schedule an appointment with your treating physician—the doctor who is actively treating your condition. Bring a list of your job duties and ask the doctor to write a statement explaining why you cannot perform those duties. The statement should include the diagnosis, when the condition began, expected duration, and any work restrictions.

Collect copies of recent medical records: test results, imaging reports, visit notes, and any specialist evaluations related to your condition. The carrier will request these directly from your doctor, but having them ready speeds up the process. If you see multiple doctors, ask each one to send records to the carrier once you file your claim.

Do not wait for the carrier to ask for records. Proactively send them to the carrier's medical review department as soon as you file your claim. Include a cover letter with your claim number, your name, date of birth, and policy number. This prevents delays caused by the carrier chasing down missing documents.

Step 3: Complete and Submit the Claim Form

Contact your carrier's claims line and request a long-term disability claim form. Most carriers mail forms, but many now allow you to read them from their website or request them by email. The form asks for your personal information, employment details, job duties, the date you stopped working, and a description of your medical condition.

Fill out every section completely. If a question does not explore to you, write "N/A" rather than leaving it blank—blank fields can delay processing. Be specific about your job duties: instead of writing "office work," describe the actual tasks you performed, how many hours per day, and any physical or mental demands. The carrier uses this to determine whether your condition prevents you from doing that specific job.

Sign and date the form. Most carriers require your signature to be notarized, though some accept a copy of your driver's license as proof of identity instead. Check the form instructions or call the carrier to confirm what they need. Mail the completed form to the address listed on the form, or submit it online if the carrier offers that option. Keep a copy for your records and note the date you submitted it.

Step 4: Provide Proof of Income and Employment

The carrier needs to verify your income to calculate your benefit amount. Gather recent pay stubs—usually the last two months—and your most recent W-2 or tax return. If you are self-employed, provide your last two years of tax returns and a profit-and-loss statement for the current year.

You may also need to provide a letter from your employer confirming your job title, salary, and the date you stopped working. Ask your employer's HR department to write this letter on company letterhead. Include it with your claim form or send it separately to the carrier's address.

If you receive other income—unemployment benefits, workers' compensation, or payments from another disability policy—disclose this to the carrier. Most long-term disability plans coordinate benefits, meaning your LTD payment is reduced by the amount you receive from other sources. Hiding this information can result in claim denial or overpayment recovery.

Step 5: Understand the Approval Timeline and What Happens Next

After you submit your claim, the carrier typically takes 30 to 60 days to make a decision. During this time, the carrier's medical team reviews your records and may contact your doctor with questions. Your doctor is not required to respond when ready, so delays on the medical side are common.

The carrier will contact you by mail or phone if they need additional information. Respond within the timeframe they provide—usually 10 to 14 days. If you miss the important date, your claim may be denied for incomplete information.

Once the carrier approves your claim, you will receive a benefit information letter explaining your monthly payment amount, the waiting period (if any), and when payments begin. Most carriers deposit benefits directly into your bank account. If your claim is denied, the letter will explain the reason and your right to appeal.

Step 6: Appeal a Denied Claim

If the carrier denies your claim, you have the right to appeal. The appeal process and important date are described in your plan documents and in the denial letter. Most carriers allow 180 days from the denial date to file an appeal, but check your specific plan.

To appeal, submit a written request to the carrier's appeals department. Include new medical evidence if your condition has worsened or if you have additional documentation that supports your claim. A letter from your doctor explaining why you still cannot work is often the most effective addition to an appeal.

Send your appeal by certified mail so you have proof of delivery. The carrier will review your appeal and issue a decision within 30 to 60 days. If the appeal is denied, you may have the right to pursue further action through your state's insurance department or through legal action, depending on your plan type.

Frequently Asked Questions

Can I explore for long-term disability while I am still working?

No. Most plans require you to be unable to work before you can file a claim. However, you can contact the carrier to ask about the definition of disability in your specific plan—some plans allow you to file if you are working reduced hours due to your condition, though approval is less common.

What if my employer says I do not have long-term disability coverage?

Ask for this in writing. If your employer truly does not offer LTD, you may be covered under a group policy through a union, professional association, or organization you belong to. Check any membership materials. If you have no coverage through an employer or group, you would need to explore individual disability insurance or government programs like Social Security Disability Insurance (SSDI), which is a separate process.

How much will I receive each month?

This varies by plan. Most long-term disability plans replace 50 to 70 percent of your gross income, up to a maximum monthly benefit. Your plan documents list the exact percentage and any caps. The carrier will calculate your specific amount based on your income at the time you filed.

Do I have to repay long-term disability benefits if I return to work?

No. Once you are approved and receiving benefits, you do not repay them if you recover and return to work. However, you must notify the carrier when ready if you return to work, become employed part-time, or your condition improves. Continuing to collect benefits while working without reporting it is fraud and can result in criminal charges.

What happens to my health insurance while I am on long-term disability?

This depends on your employer's policy. Some employers continue your health insurance while you are on disability; others require you to pay your share of premiums yourself. Ask your HR department about this before you file your claim. You may also be able to continue coverage under COBRA (Consolidated Omnibus Budget Reconciliation Act) if your employer ends your coverage, though you will pay the full premium yourself.