My long term disability claim administrator has a criteria for long term disability "Participant is continuously unable to perform any occupation for which he is or may become qualified by reason of his education, training or experience." Is this standard language for DI policies. It seems not very clear cut to me. Where might I find an explanation of it? Thanks.
Disability Criteria
- Thread starter cajun
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Yes, very clear and standard. There are two basic types of definition of disability; 1) cannot perform their own occupation, and, 2) cannot perform any occupation for which qualifed (yours). The first one, commonly referred to as "own occupation" is more expensive when compared to "any occupation" definition.
Let's use an example. If a surgeon becomes disabled due to a hand disability, they cannot do surgery (their own occ) but can they teach? Probably. So if the definition is "own occ", they are disabled, if it's "any occ", they would not.
Let's use an example. If a surgeon becomes disabled due to a hand disability, they cannot do surgery (their own occ) but can they teach? Probably. So if the definition is "own occ", they are disabled, if it's "any occ", they would not.
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leevena
Thanks for your answer. I understand the difference. My concern is how inventive the claims company might be in dreaming up some job that I might do. I have an upper spinal cord injury. I can walk. I have poor hand dexterity and touch sensation, significant muscle spasticity and fatigue. I was an electrical engineer. I can do most things but much slower, and I tire easily. How does parttime work apply? Thanks again.
Thanks for your answer. I understand the difference. My concern is how inventive the claims company might be in dreaming up some job that I might do. I have an upper spinal cord injury. I can walk. I have poor hand dexterity and touch sensation, significant muscle spasticity and fatigue. I was an electrical engineer. I can do most things but much slower, and I tire easily. How does parttime work apply? Thanks again.
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So much of this will depend upon the exact language in the contract. Was this a policy through work, or one you purchased independently from an agent? The policy through work is likely to have a definition of disability that will be much harder to meet than one you purchased outside of work.
Do you have a copy of the policy, can you post the clause that defines disability?
Do you have a copy of the policy, can you post the clause that defines disability?
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Cajun,
I don't know the answer, but I'm curious as well. I've had four disability claims so far, all went very smoothly. However, all were on group or voluntary employer based plans. Three with Hartford, one with Illinois Mutual. Three were due to surgeries that put the employee out of work for a while, one was a motorcycle accident. Fairly clear cut.
I have a client with a claim that is brewing due to an illness that is slowly impacting his ability to work, but a claim has not been submitted as of yet. It's on an individual policy with a very similiar definition to the one you posted. I'm really hoping they don't put him through the ringer as he is just getting outside the two year contestability period. Time will tell.
FT
I don't know the answer, but I'm curious as well. I've had four disability claims so far, all went very smoothly. However, all were on group or voluntary employer based plans. Three with Hartford, one with Illinois Mutual. Three were due to surgeries that put the employee out of work for a while, one was a motorcycle accident. Fairly clear cut.
I have a client with a claim that is brewing due to an illness that is slowly impacting his ability to work, but a claim has not been submitted as of yet. It's on an individual policy with a very similiar definition to the one you posted. I'm really hoping they don't put him through the ringer as he is just getting outside the two year contestability period. Time will tell.
FT
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