If you have a disability insurance policy, it is important to understand what that policy covers in case you ever lose your ability to work due to an illness or physical injury. Policies differ with regard to the type of conditions covered, the length of time of coverage, and exceptions that may apply. Below are examples of terms and conditions that vary. Not applying for the appropriate benefit could result in a claim delay or denial.
Total vs. partial disability
Insurance companies often define a disability as a Total Disability or a Partial Disability. Depending on the Policy, a Partial Disability is one that reduces your ability to do your job but still lets you work at a reduced capacity in either your own occupation or another occupation. Although the definition of “Total Disability” varies, it basically means the Insured is unable to perform the material duties of his/her own occupation and/or any gainful occupation. Some policies are strictly “Own Occupation” polices and others have an “Own Occupation” period of disability followed by an “Any Occupation” period of disability.
Physical vs. Mental Health Disabilities
Most disability insurance providers treat claims based on a physical disability differently than ones based on a mental condition or cognitive issue. Specifically, many policies limit benefits for mental and cognitive disabilities to 12 or 24 months. When a policy contains one of these time limits, the insurance company is motivated to label a disability mental or cognitive rather than physical.
For example, the insurer might approve a claim based on the insured person’s depression diagnosis. While the depression could be real, it is often a side effect of developing a physically limiting disability like a long standing chronic pain, MS, arthritis or other physical illness. A dispute may arise over whether the claimant’s disability and inability to work is caused by the physical or mental condition.
Accident/Injury vs Sickness
Another important distinction is whether the disability is the result of an accident or an illness. Once again, the origin of your condition can limit how long you will receive benefits. Many policies limit illness-related disability payments to a maximum benefit period time frame (24 months, 5 years, age 65) but pay benefits for life if the disability is due to an injury. As with different treatment of physical versus mental disabilities, the insurer may try to claim that a physical injury is actually an illness so they can pay less money.
Don’t settle for less with your claim
There are many factors potentially involved in getting your disability insurance claim properly approved. Your family’s financial security could be at stake. Thankfully, you do not have to deal with a policy claim or appeal on your own. Our experienced attorneys are here to help you at every step of the process. To learn what level of benefits you are entitled to, contact Disability Insurance Law Group for a free consultation.