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What are they?  How do I deal with them?


There are two general philosophies of disability insurance marketed during the past 20-30 years. The first philosophy insures you with a policy where “total disability” means your  inability, caused by an accident or sickness, to engage in your regular occupation. “Regular Occupation” is the occupation or occupations you were engaged in at the time of disability. These types of policies are commonly known as “own occ” policies. At its most competitive end, “own occupation” is specified or at least recognized by the insurer as a “specialty” within medicine or surgery, dentistry, law and other professions. Therefore, if you are disabled within your occupational specialty but could work in some other occupation, you would be entitled to “total disability” benefits. With the addition or inclusion of “residual disability” (also called “partial” or “proportionate”) disability, you have a comprehensive policy that should be purchased by most executives or business owners, many “white collar” and some “gray collar” workers and all “professionals.”

The second of the two general philosophies of disability policies are called ‘Loss of Earnings” policies and they focus not on the occupation of the insured but whether you have a loss of income due to a disability caused by an accident or sickness. If you are disabled due to an accident or sickness and suffer at least a 20% loss of income you are paid a benefit. These policies are generally marketed to business owners, “white collar” and some “gray collar workers (and professionals who use their hands or work with manufacturing machinery). Many of the same types of policy “options” are available to both philosophies.

When you are “totally” or “residually” disabled and are eligible for disability benefits, a phone call to the company will trigger the disability claim package to you. You read the short instructions and begin completing the application for disability claim. This unfortunately, is when the general public begins their nightmare of details that can be very “sensitive” to whether they are paid or not paid. This entire “claim process” is foreign to most of us. The assumption is, the disabled insured truly understands what is being asked of them by simply reading the claim forms. Even more important in many claim situations, is knowing what coverage you have, how and when is it paid, what additional claim information, medical information and financial information is needed to begin and then conclude a decision to pay you. How and when might video surveillance be used to investigate your claim? Will the company send you for an “independent medical examination.”? What other “tools” does the company use to measure your disability and/or your loss of income?

This process is full of “land-mines” and the claimant is about to step into on first one if he or she goes it alone.

Before filing for disability insurance benefits, seek professional help through an independent claims consultant who can help you through the maze of details, and more!

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Disability Insurance Claims

What are they?
How do I deal with them?
Key Disability Insurance Policy Clauses

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