Long-Term Disability Quotes






It's impossible to get "instant" quotes for long-term disability insurance. Premiums are influenced by many factors and the more correct information provided the more accurate your quotes will be.

To receive comparison quotes from several of the leading long-term disability insurers, please answer the questions below. Within 1 to 2 business days, I will complete your quotes and send them to you along with a comprehensive, easy to understand product comparison summary.

Not all of the fields below are required to be completed--but the more information you provide, the more effectively I can help you.



Contact Information


Your name:

Your email address:

Your street address:

Your city:

Your state:

Your zip code:

Your day phone number:

Your evening phone number:

Net annual income:

Your occupation:

Do you work from home? If so, what percentage of the time?

Your date of birth:


Are you a business owner?


Company: Are you: Self-employed or a C-Corp

Number of employees:
Years in business:


Are you a government employee?


Years of government employment:

Type of employment: Federal State County Other



Group Long-Term Disability
(Please fill out this section if you have a group disability policy)


Do you have a group long-term disability policy in force now? Yes No

If so, what is the monthly amount?

60% 67%

Employer paid? Yes No


Individual Long-Term Disability
(Please fill out this section if you have an individual disability policy)


Do you have an individual long-term disability policy in force now? Yes No

If so, what is the monthly amount?

Do you intend to keep this policy in force? Yes No


What benefits do you wish to have quoted?


Who will pay the premium? My Employer Me

Monthly benefits:

Elimination Period: 60 days 90 days 180 days 365 days

Benefit period: 2 years 5 years to age 65 66/67

Benefit riders: SSIB Residual benefits COLA Non-cancelable Return of premium CAT Own occupation Future Purchase Option No riders


Health information


What is your height:

What is your weight:

What is your history of tobacco use:



List your prescription medications below:


List the reason(s) for which each of your medications has been prescribed:

Any chronic illness or any other illness not yet mentioned:




Click on the 'Submit Query'' button and I'll get to work on your long term care insurance quote comparisons. I'll have them completed within 1 to 2 business days.









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