Long-term disability insurance policies can be complicated. The language is unique and contains terms and phraseology not often seen before. If you have short- and/or long-term disability coverage, understanding the following key elements of your policy is crucial to knowing what protections you have – and when an insurance company may have failed to honor the policy’s promise.
In general, here are the essential features of disability insurance policies to understand:
- The definition of ‘disability’ – The most important paragraph of the policy. How a policy defines the term “disability” will impact when benefits are payable. While these definitions can vary significantly across different providers and polices, in general, they tend to describe disability as being an impairment that prevents the policyholder from working or earning a living. Most policies contain both an “own occupation” followed by an “any occupation” definition that kicks in after a certain period of time that benefits have been paid, often times two years.
- Benefits – This aspect of disability insurance will detail how and when benefits are paid out, as well as the duration of benefit payments and grounds for terminating benefits. Provisions regarding benefits may also explain when “residual benefits” may be paid out, when benefits may be subject to cost of living adjustments (COLAs), etc.
- Limitations – Nearly, all long-term disability policies will limit the circumstances for which benefits are payable. The typical limitations are those relating to substance or alcohol abuse, mental illness disabilities (including even depression and anxiety) and even more general categories such as all disabilities arising out of “self-reported symptoms” or based on certain medical conditions such as headaches, arthritis, fibromyalgia, chronic fatigue syndrome, migraines, and still others.
- Endorsements – These are typically provisions regarding add-ons or additional coverage features or options purchased (beyond the standard plan or policy). While endorsements can come with an additional cost, they can offer additional protections.
- Exclusions – These provisions will detail the limits of the coverage, such as specific circumstances or conditions that the policy will not cover. For instance, it’s not uncommon for disability insurance policies to exclude pre-existing conditions or disabilities from natural disasters, criminal activity or wars.
- Elimination or waiting periods – This refers to the amount of time policyholders will need to wait before receiving benefit payments for approved claims. It should be noted that waiting periods for short- versus long-term disability policies can vary widely, ranging from as little as 14 days for some short-term disability policies to upwards of 180 days for some long-term disability policies.
Disability Insurance Coverage: The First Step in Protecting Yourself
The average worker has a roughly 1 in 3 change of becoming disabled, and about 1 in every 8 workers in the U.S. will be unable to work for at least 5 years due to a disability. Knowing this, it’s clearly crucial to have short- and long-term disability coverage.
However, it’s also critical to understand that insurance providers are not always forthright about honoring the policies they issue or protecting the rights of their policyholders.
To fully protect yourself when it’s time to file a short- or long-term disability claim or to respond to a denied claim, the best thing you can do is to retain an experienced lawyer like Attorney Shawn E. McDermott.
Contact Colorado Disability Lawyer Shawn E. McDermott
Do you want to know if your disability insurance covers your ailment? Or do you need help appealing a denied disability insurance claim? If so, you can turn to Colorado Disability Lawyer Shawn E. McDermott for honest answers and superior representation moving forward. Dedicated and experienced, Shawn McDermott has a record of success when it comes to helping people stand up to insurers and secure the benefits to which they are entitled.
To learn more about how Colorado Disability Attorney Shawn E. McDermott can help you, set up a complimentary consult with our office today by calling (303) 964-1800 or by emailing our firm using the contact form on this screen.
From our offices in Denver, we provide the highest quality legal services to disabled people throughout the state of Colorado, the surrounding states and nationwide.