Our disability clients are often surprised to hear that their life insurance coverage may continue in full force and effect even if they are disabled and cant work. Most individuals have coverage in the event of disability or death through benefits or policies of insurance provided by their employer. If so, such claims are likely governed by ERISA (Employee Retirement Income Security Act). Most group life insurance policies contain what is often called a “waiver of premium” provision which provides that the life insurance protection continues without having to pay a premium if the employee becomes disabled. The life insurance policy will define the term “disabled” which may be different from the definition found within the employee’s disability benefit plan or policy.
Most disability policies will pay benefits if the insured is unable to perform the material or substantial duties of their “own occupation.” However, after two years, the typical group policy definition changes such that an insured must then prove an inability to perform “any occupation.” Most waiver of premium provisions found in life insurance policies define disability as the inability to perform “any occupation.”
If you are pursuing a disability claim under a policy of insurance which you have purchased on your own or have by virtue of your employment, you will want to check your life insurance policy to determine if there is such a waiver of premium provision. If so, and you meet the conditions, you will need to submit a separate claim to the life insurance company (which is often the same company as the disability insurance carrier but not always) for the waiver of premium provision to apply. There are usually time limits on such applicaton.
Please feel free to contact our office if you have any questions regarding such claims or if your life or disability insurance claim has been denied.