Where Long-Term Disability Claims Actually Go

Long-term disability (LTD) is usually sold and managed by your employer or purchased privately, not by Social Security. When you file, you are submitting a claim to an insurance company — often Unum, MetLife, Cigna, or another carrier — not to a government agency. The process starts with your employer's human resources or benefits department, or directly with the insurance company if you bought the policy yourself.

The insurer will ask for medical records, work history, and proof that you cannot perform your job. They make the decision about whether to pay, how much, and for how long. This is separate from Social Security Disability Insurance (SSDI), though some people file for both at the same time because the timelines and rules are different.

Key Takeaways

  • Contact your employer's HR or benefits department first — they hold the policy documents and can tell you which insurance company manages your plan and what forms to use.
  • You will need recent medical records from your doctor, a detailed description of your job duties, and documentation of when you stopped working due to your condition.
  • The insurance company typically has 30 to 45 days to make an initial decision, though they may request more information and extend that timeline.
  • If your claim is denied, you have the right to appeal within a set window — usually 60 days — and can submit additional medical evidence or hire a representative to help.
  • Some LTD plans coordinate with SSDI, meaning if you receive SSDI benefits later, your LTD payment may be reduced by that amount.

Step 1: Locate Your Plan Documents and Contact Information

Your first move is to find out whether you actually have long-term disability coverage. Check any benefits materials your employer gave you when you were hired, or ask your HR department directly. They can tell you the name of the insurance company, the policy number, and whether the plan is employer-paid or employee-paid (or both).

If you bought a private LTD policy on your own, check your policy documents or contact the insurance company listed on your premium statements. Write down the insurer's name, your policy number, and the phone number for claims. Keep these details in front of you throughout the process.

Step 2: Gather Medical Evidence Before You File

The insurance company will not take your word that you cannot work. You need medical documentation showing your diagnosis, treatment, and functional limitations. Contact your primary care doctor and any specialists treating your condition (rheumatologist, cardiologist, psychiatrist, etc.) and ask them to send recent medical records to you.

Request records from the past 3 to 6 months, including office visit notes, test results, imaging reports, medication lists, and any restrictions your doctor has placed on your activities. If your doctor has written a statement about your ability to work — for example, "Patient is unable to perform sedentary work due to chronic pain" — ask them to include that explicitly. The more specific the medical evidence, the stronger your claim.

Step 3: Complete the Claim Form and Submit Supporting Documents

Contact the insurance company or your HR department and request the long-term disability claim form. This form asks for your name, policy number, date you stopped working, and a description of your medical condition. You will also need to describe your job duties in detail — not just your job title, but the actual tasks you performed, how many hours per day, and what physical or mental demands the job required.

Gather these documents before you submit:

  • Completed claim form, signed and dated
  • Medical records from the past 3 to 6 months
  • A letter from your doctor describing your condition and why you cannot work
  • Proof of income (recent pay stubs or tax returns)
  • A detailed written description of your job duties
  • Any other medical evidence relevant to your claim (hospital discharge summaries, therapy notes, etc.)

Submit everything together to the address or email listed on the claim form. Keep copies of everything you send, and ask for a confirmation number or receipt showing the insurer received your claim.

What Happens After You File: The Review and Decision Timeline

Once the insurance company receives your claim, they have a set number of days — usually 30 to 45 — to make an initial decision. During that time, they may request additional information from you or your doctor. If they ask for more records, respond as quickly as possible; delays on your end can extend the timeline.

The insurer will review your medical records against the definition of disability in your policy. Most policies define disability as the inability to perform the duties of your own occupation, though some change the definition after a certain period (for example, after two years, you may need to prove you cannot perform any occupation for which you are reasonably suited by education or experience).

You will receive a written decision in the mail. If approved, the letter will state the monthly benefit amount, the start date of payments, and the expected end date (or whether benefits continue until age 65). If denied, the letter must explain the reason and tell you how to appeal.

How to Appeal a Denial

If your claim is denied, you have a limited window to appeal — typically 60 days from the denial letter, though check your policy for the exact important date. An appeal means you are asking the insurance company to reconsider their decision.

For an appeal, gather any new medical evidence that has accumulated since your original claim — new test results, updated doctor's notes, or a stronger statement from your physician about your inability to work. Write a letter explaining why you believe the denial was wrong, referencing specific parts of your medical records and your policy's definition of disability.

Some people hire a disability attorney or advocate to handle the appeal, especially if the claim is large or the medical evidence is complex. An attorney can review the insurer's reasoning, identify gaps in their logic, and present a stronger case. Many work on contingency, meaning they take a percentage of back pay if you win, rather than charging an upfront fee.

How LTD Coordinates With SSDI and Other Benefits

If you receive long-term disability payments and later become approved for Social Security Disability Insurance (SSDI), your LTD benefit may be reduced. This is called offset or coordination of benefits. The exact reduction depends on your policy language, but typically your LTD payment drops by the amount of your SSDI benefit so that your total income from both sources does not exceed a certain percentage of your pre-disability earnings.

Some LTD plans also coordinate with workers' compensation or other disability programs. Read your policy documents carefully to understand how offset works in your case. If you are receiving LTD and file for SSDI, notify your LTD insurer of your SSDI decision as soon as you receive it, because they will ask for proof of the award amount.

Frequently Asked Questions

How long do I have to be out of work before I can file for long-term disability?

Most LTD policies have an elimination period (also called a waiting period) of 30, 60, or 90 days. You must be unable to work for that entire period before benefits begin. Some policies require you to use up all paid time off during the elimination period. Check your policy documents for the exact elimination period and whether it applies to your situation.

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

Ask HR to provide that statement in writing and to confirm it in your personnel file. If you believe you should have coverage, check any benefits materials from when you were hired or any plan summaries sent to employees. If you purchased a private policy, contact the insurance company directly — they have records of all active policies. If coverage truly does not exist, you may be able to file for SSDI instead.

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

This depends entirely on your policy. Some plans allow part-time or reduced-duty work and reduce your benefit proportionally. Others have a strict definition: if you earn any income above a certain threshold, benefits stop. Read your policy or ask the insurer before you attempt any work, because earning income without permission can result in overpayment and a demand to repay benefits.

What if the insurance company asks me to see their doctor?

The insurer may request an independent medical examination (IME) to verify your condition. You are generally required to attend. Bring all your medical records and be honest about your symptoms and limitations. The IME doctor works for the insurance company, not for you, so their report may not be favorable — but refusing to attend can result in claim denial.

How much will I receive in long-term disability benefits?

This varies by policy. Most plans replace 50 to 70 percent of your gross income, up to a maximum monthly benefit stated in the policy. Some policies have a flat dollar maximum (for example, $5,000 per month), while others cap benefits at a percentage of your salary. Check your policy documents or ask HR for the exact benefit amount you would receive.