My rheumatologist has declared me disabled. I had applied for long-term disability through my employer when I was taken off work a year ago. I have been denied the benefit twice. They said I do not meet their disability guidelines. The doctor has stated that I am unable to work due to pain, fatigue, depression and fibromyalgia. We tried some time off to see if it would help, but as soon as I returned to work, things got worse. My understanding was that, after a waiting period, I would receive some help in the first two years after becoming unable to work as long as I could not perform my current occupation, and then after that only if I was unable to do any kind of work. If this is so, then how can I be denied at least the first two years?

R.C.

In the world of disability insurance, there are two hemispheres -- long-term and short-term. While the benefits each offers are similar, the purposes are different and the benefit triggers are different. As one might assume, it is much more difficult to qualify for long-term disability than short-term disability.
The assumption behind long-term disability is that a person's condition is so severe that she or he will not be able to return to work in any capacity. Depending on the terms of the disability insurance contract, this could mean that once diagnosed and once approved for benefits, the insured person could receive disability payments for a long, long time. So it is a major decision to approve someone for long-term disability.

In recent years, insurers have tightened long-term disability contracts and strengthened the scrutiny of qualifying diagnoses and conditions. The problem is that disability insurance misuse has increased tremendously in the past decade. For example, a recent investigative television news story uncovered several cases of former New York police officers receiving payments for total disability who were working as full-time police officers in Florida. Obviously, these people were not disabled in the least. Perhaps the nature of their injury would have an effect on their ability to perform the duties of New York city police officer, but it did not hinder them from gainful employment as a police officer. These examples are probably perched on the tip of an iceberg.

The assumption behind short-term disability is that the injury or illness would have a limited duration and, therefore, a limited effect on a person's ability to do his or her job. In other words, the disability may be temporary and keep a person off the job for a short period of time. Obviously, this kind of liability is less than that of a permanent disability, so qualifying for the benefit is not as stringent.

There is one more aspect of disability insurance regarding the nature of a disability. Does the disability mean that you cannot do ANY work, or does it only limit you from working in your current position?

You state that your disability insurance carrier has rejected your claim. You do not indicate in your question how you have pursued this situation. Have you had a discussion with the carrier regarding the reason for the denial? On what basis has the carrier declined your application for benefits? Are you covered for short-term disability?

Since provisions vary from contract to contract, I cannot speak for the way your disability insurance works. The denial of benefits may not be related to the waiting period but, rather, to the nature of your medical condition and the nature of your coverage. If you cannot get a satisfactory explanation from your insurance carrier, perhaps your employer's benefit manager can help you. If the case is that your disability does not rule out any kind of work, perhaps your employer has a way for you to do SOME kind of work.

Have discussions with your employer and insurer and get to the bottom of your situation. Make sure you have complete information from your physician and be ready to send it to the insurance company. You may also need further information from your doctor, such as a letter of explanation. The outcome may be that you come away with a better understanding of your coverage, and the insurer comes away with a greater understanding of your medical condition.