7 Things You Should Know About Texas Long Term Disability

August 25, 2020 | J. Price McNamara
7 Things You Should Know About Texas Long Term Disability

When you have to apply for Texas long term disability benefits, it means something that has transpired that has limited your ability to work and provide for your family. Before you apply for benefits, there are several things you need to consider.

7 Things You Should Know About Texas Long Term Disability

1. Clause For Pre-Existing Conditions

One of the first things you should review before pursuing long term disability benefits in Texas is the pre-existing condition clause in your policy. This clause refers to any conditions that a person had prior to applying for the disability within the 3 months leading up to the start of the coverage. There would be no benefits distributed for medical conditions that existed during this time for the first 6 months that you are enrolled for disability coverage. At the end of the initial 6 months, a waiting period will begin and at the close of that period, you may begin receiving benefits.

2. Eligibility For Texas Long Term Disability

Determining whether or not someone is eligible to receive long-term disability benefits is a multi-faceted step that takes place at the beginning of the process. In order to be eligible, you will generally need to meet the following criteria:
  • Completion of the required waiting period for benefits
  • Assessment by a physician with a certification of disability that meets the policy’s requirements
  • Have a third-party approval for benefits
These different factors of eligibility for long term disability in Texas can vary based upon each individual situation. Not all beneficiaries will gain access to their benefits the exact same way.

3. The Required Waiting Period

No matter how you become eligible for benefits through Texas long term disability, you must first go through a waiting period, the length of which is dependant on your condition and the situation that prompted you to become a candidate for coverage. First and foremost, you will generally be required to use any sick leave time that you have accrued through your employer before you become eligible for benefits. The standard waiting period for most candidates is 180 days. This is to eliminate the pre-existing conditions clause and allow them the opportunity to become eligible for the benefits. It is important to note that you are not required to use both the sick leave balance and the 180-day waiting period. The longest of the two periods will be utilized and then your eligibility will be in effect.

4. Enrolling In The Coverage

Enrolling into long term disability can be done either through the Hire or Rehire period. You will not be required to show proof of insurance and your coverage would take effect immediately when enrolled during this period. Once you are hired, you have up to 31 days to enroll in this insurance coverage option. When you enroll in this coverage, the benefits will begin the following month after enrolling in the coverage as opposed to being available immediately. If you did not choose to opt into this coverage during this time, you could still enroll later, after a significant life event (such as a birth or marriage) has changed your status. This will require additional policy approval, but once you have received that, the coverage will apply the following month.

5. Your Coverage Period

Your age at which you begin utilizing your disability will determine your coverage period. The coverage period will begin after the waiting period has ended and you are approved to begin receiving benefits. At that time, you will receive compensation until you are able to return to work or until you reach your full Social Security benefits package age, whichever comes first. For those who are 69 years of age or older will generally be eligible to receive long-term disability benefits for a period of up to 12 months.

6. What To Expect Monthly

The monthly benefits that you are eligible to receive vary depending on salary and other income that you may be receiving. The maximum amount of benefits that a beneficiary can get is 60% of your monthly salary. There is also a $6,000 cap on this amount, meaning that if 60% of your salary is more than $6,000, you will only be eligible to receive $6,000. Additionally, there is a minimum amount that all beneficiaries receive. You are entitled to at least 10% of your total salary when receiving these benefits during your coverage period.

7. Other Compensations & Incomes Are Considered

When your monthly benefits are calculated and before they are distributed, your total income calculations will be considered to ensure that you are receiving a fair amount but also not receiving excess compensation. The income you are receiving from worker's compensation coverage will be factored in as well as any partial Social Security income that you are receiving.

Be Prepared For Texas Long Term Disability Benefits

If you are looking into pursuing Texas long term disability coverage to compensate for the income that you have lost due to a new disability, then you need to prepare yourself for the steps above and the process that happens when you apply. If you have been denied benefits and are trying to figure out your next steps, contact a long-term disability denial lawyer as soon as possible to help make sure you are paid the benefits that you are due.
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J. Price McNamara


Losing my own brother, then my father and sister after long, disabling illnesses just a few months apart drove a career change for me. Before that experience, I never truly understood the place you’re in. I never understood the dramatic impact that receiving (or not receiving) the disability and life insurance benefits you paid for and counted on can have on your life especially when you need to focus on family and healing. What I experienced with my own family now drives the way I view my clients and my work, and I will never forget it!

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