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What medical conditions qualify for disability insurance?
The list of covered illnesses and injuries comes down to the type of policy you have.
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Disability insurance is designed to protect your paycheck if you can’t work due to an illness or injury — but it isn’t a catch-all policy. Your insurer will only pay benefits if your condition is specified in your policy, and the list of conditions differs between short-term, long-term and Social Security disability.
What's in this guide?
What conditions qualify for short-term disability insurance?
Short-term disability (STD) insurance protects your paycheck when you can’t work for a short period of time — typically three, six or 12 months.
Since it caters to short-term needs, STD tends to cover temporary disabilities and conditions with a relatively quick recovery time. These include:
- Disabling injuries — like broken legs, feet or hands
- Prolonged illnesses — such as glandular fever
- Bone, joint and spine disorders — like arthritis, back pain and tendonitis
- Chronic digestive disorders —including gastritis and Crohn’s disease
- Mental health conditions — like depression and chronic anxiety
- Pregnancy and maternity leave, in some cases
When does short-term disability pay out for pregnancy?
You may not think of pregnancy as a disability, but many insurers classify it as one under their STD policies.
If you purchased a policy before you became pregnant, you may be eligible to receive benefits for six weeks after a vaginal delivery and eight weeks after a C-section. If you have a high-risk pregnancy or experience complications, hypertension or postpartum depression after childbirth, your disability benefits might be payable for longer.
Insurers treat pregnancies differently, so check the parameters of your policy before filing a claim.
Disability insurance and pregnancy
What conditions qualify for long-term disability insurance?
Depending on the benefit period you choose, long-term disability (LTD) replaces a portion of your paycheck for two, five or 10 years, or until you reach retirement age.
This policy typically pays out for severe or lifelong injuries and illnesses. Your insurer may cover:
- Chronic bone, joint and connective tissue disorders — like osteoarthritis, chronic back pain or slipped disks.
- Accidental injuries — such as brain trauma caused by a car accident.
- Cardiovascular conditions — including heart attacks or serious heart conditions.
- Circulatory disorders — like coronary artery disease.
- Prolonged mental illnesses — like PTSD and major depressive disorders.
- Cancer.
- Poisoning.
What conditions qualify for Social Security Disability Insurance?
To qualify for Social Security Disability Insurance (SSDI), you’ll need to prove you’ve worked in jobs covered by Social Security for a certain number of years, and meet the Social Security Administration’s definition of disability.
Your condition must significantly impact your ability to work for at least 12 months.
List of conditions covered by SSDI
The Social Security Administration manual that lists a number of physical and mental impairments that qualify for SSDI and Social Security Income (SSI).
Known as the “blue book,” the 2020 version includes these conditions:
- Musculoskeletal problems — like back injuries
- Cardiovascular conditions — such as heart failure and coronary artery disease
- Senses and speech issues — like vision and hearing loss
- Respiratory illnesses — such as chronic obstructive pulmonary disease (COPD) and asthma
- Neurological disorders — such as multiple sclerosis (MS), cerebral palsy, Parkinson’s disease and epilepsy
- Mental health conditions — including depression, anxiety, autism and intellectual disorders
- Immune system disorders — like lupus, rheumatoid arthritis and HIV/AIDS
- Severe skin disorders — including dermatitis
- Digestive tract disorders — such as liver disease or inflammatory bowel disease
- Hematological disorders — like hemolytic anemias and bone marrow failure
- Kidney disease
- Cancer
- Various syndromes — such as Marfan Syndrome and Sjogren’s Syndrome
Can I get disability insurance with a preexisting condition?
Most likely — but your preexisting condition may not be covered under your policy.
Most insurance companies will happily offer you a policy, but exclude your condition from coverage for a set period of time. This means that if you become disabled and your disability is linked to a preexisting condition within the specified time frame, your insurer will deny the claim. However, it will pay benefits for a disability that isn’t directly tied to your preexisting condition.
Let’s say you’ve had heart surgery in the past. If you suffer a heart attack or stroke shortly after starting your policy, your disability insurance probably won’t pay out. But if you suffer an unrelated disability — like back pain — you should be eligible for benefits.
Some disability insurers are stricter than others, and will reject your application altogether, which is why it’s worth comparing policies from a handful of companies.
Disability insurance and preexisting conditions
Will my preexisting condition affect my disability insurance rates?
No. Disability insurance rates are primarily based on your age, health and occupation, as well as your chosen benefit and elimination period.
Can I be covered by both Social Security Disability Insurance and private disability insurance?
Yes. You can qualify for SSDI and private disability insurance benefits at the same time, and for the same disability.
But you won’t necessarily receive the full benefit from both policies. If you’re eligible for SSDI, your insurance company may deduct your SSDI payments from your private benefits. So if you qualify for a $2,000 monthly benefit from your long-term disability insurance policy but also qualify for $500 from SSDI, your LTD policy may only pay $1,500 a month.
The same goes for workers compensation and military benefits for veterans. You can qualify for these programs while receiving SSDI and private disability benefits.
What conditions aren’t covered by disability insurance?
Every disability policy has a list of exclusions — injuries and illnesses that don’t qualify for coverage.
They vary between insurers, but these are the most common limitations:
- Specific preexisting conditions
- Conditions caused by substance abuse — including prescription drugs
- Normal pregnancies with no complications
- Workplace injuries
- Intentional injuries and self-harm
- Injuries caused by acts of war
Does disability insurance cover coronavirus?
Yes — most policies will cover you if you contract coronavirus and can’t work. But if you got COVID-19 before you applied for disability insurance, your insurer may consider it a preexisting condition and deny the claim.
What should I watch out for?
Along with your insurer’s definition of disability, the terms of your policy can also affect your coverage for certain conditions.
When you’re shopping around for a policy, take note of these terms.
Own-occupation vs. any-occupation
Your disability insurance plan will fall into one of two categories:
- Own-occupation policies pay benefits if you can’t work in your usual job, but you can work a different job. Let’s say your back pain prevents you from doing your construction job, but you can work in your company’s office — an own-occupation policy would still pay out benefits.
- Any-occupation policies only pay out if you don’t have the physical or mental capacity to do any job.
Off-the-job coverage vs. 24-hr coverage
Your disability insurance policy will either provide off-the-job coverage or 24-hour coverage.
A 24-hour policy covers you around the clock, while off-the-job coverage comes into play if you suffer a disability when you aren’t working. It’s designed to compliment worker’s compensation.
Compare disability insurance companies
Bottom line
Your disability insurance will only cover conditions that are listed under your policy. Each insurer has its own definition of disability — but STD policies typically pay out for conditions with a shorter duration or recovery time, while LTD covers long-term disabilities.
To get the most comprehensive coverage for your needs, compare disability insurance companies.
