What Qualifies as a Disability for Insurance Purposes?

December 17, 2019 | J. Price McNamara
What Qualifies as a Disability for Insurance Purposes? Long-term disability insurance policies vary greatly in how they define a disability. If your disability plan is covered by an employer, it is extremely likely that your plan will fall within the ERISA statute. In any case, in order to obtain benefits, it is the applicant’s job to demonstrate, based upon supporting medical evidence, that you have met the requirements of a disability under the specific language of your insurance policy. If you are not able to do that, it is extremely likely that your claim will be denied.  At J. Price McNamara ERISA Insurance Claim Attorney, our experienced team of Texas disability lawyers can help you determine if you qualify for disability benefits under your policy. Moreover, if you are initially denied access to benefits, we could assist you throughout the appeal process. Please contact us online today for more information about how we could assist you with your case. 

Obtaining a Complete Copy of Your Insurance Plan

The first thing that you should do – if you have not done so already – is to obtain a complete copy of your insurance plan from your human resources department. The plan language will precisely define the term “disability.” For example, in some instances, a particular plan might define disability as not being able to return to your specific job, while at other times, a disability might mean that you are not able to perform any kind of work, whatsoever.  An experienced Texas disability lawyer can review the plan language with you and determine whether or not you have likely met (or can meet) the definition of a disability under your policy. 

What does it Mean to be “Totally Disabled”?

To recover benefits for long-term disability, you will likely need to be totally disabled. This means that you are not able – either because of a long-term injury or illness – to substantially perform your occupational duties. In some instances, the long-term disability insurance policy will provide for partial disability benefits. This may be true if your illness or injury precludes you from working at your job full time, but you can work at some other job on either a full time or a part-time basis.  To prove that you are totally disabled, you will need to provide sufficient medical documentation. You will also likely need an impairment letter from a health care provider, stating not only that you are disabled, but the nature and extent of your limitations and impairments. An experienced disability lawyer in Texas can assist you with gathering this documentation and submitting it in a timely manner. 

Call a Texas Disability Lawyer Today

At J. Price McNamara ERISA Insurance Claim Attorney, our legal team can work to ensure that you have properly satisfied the definition of disability within the language of your insurance policy –  and that you submit the necessary documentation. To schedule a free legal consultation and case evaluation with a Texas disability attorney, please contact us online today for more information. 
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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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