Lifetime Benefits

[Rosegarden]

Trying to find some answers. A dental specialist with LTD policy with lifetime benefits for injury and lifetime rider for sickness (the policy was issued 30+ years ago) has been on claim for 20 years. At 65 definition changes to any gainful occupation with gainful defined as reasonably suited by education, training and experience. How is this definition actually interpreted in real life? Must this individual be unable to do any job or some job related to dentistry and/or in the same income level?

 

[Tahoe Ray]

Trying to find some answers. A dental specialist with LTD policy with lifetime benefits for injury and lifetime rider for sickness (the policy was issued 30+ years ago) has been on claim for 20 years. At 65 definition changes to any gainful occupation with gainful defined as reasonably suited by education, training and experience. How is this definition actually interpreted in real life? Must this individual be unable to do any job or some job related to dentistry and/or in the same income level?

This is pretty sticky.

That's similar to an "any occ" definition of disability but has some interesting language.

"Gainful" sounds like it would imply that the carrier isn't going to force him to be a greeter at Walmart or something. Practically speaking, he probably isn't going to be forced back to work if he can't practice in some similar line of work (based on medical/income/teaching dentistry, etc.). Unfortunately, there isn't really any way to tell. As you may know, carriers will not normally "hypothetical" these situations. The decision just "is what it is".

I would not advise anything other than having him stay on claim and if he is taken off claim, consult an attorney.

 

[yankee466]

Not my #1 focus of business, but I'm not used to seeing the term "lifetime benefits" and LTD in the same sentence. They tend to run out of gas at 65/70, or simply become unaffordable to keep...hence the need for LTC.

Maybe I am missing something? Obviously I have no idea what language is in this policy.

 

[scagnt83]

What Ray said. Dont give any advice or firm answers. No way to tell.

The "Gainful Employment" factor means it needs to be a job that provides meaningful income. So it would exclude being a greeter at walmart or running a cash register.

However, it does not mean the same level of income as before. Nor does it require it to be in the same profession.

Technically, they could say any job listing that pays a livable wage for the area the person lives in, and the person would be considered qualified to perform.

So if they want to get sticky about it, a former dentist, especially if they owned a practice, would have many skills that are transferable to fields other than dentistry or medicine. And that is how they are able to disqualify so many claims with that type of language. Plus there is always the option to be a teacher, which can get many people.

However, this guy has not worked in 20 years. That is a HUGE amount of technical innovation to miss out on in the workplace. And Im sure there is plenty changed in the dental profession since then. So it seems he could reasonably argue a lack of "current knowledge" in both his profession and the workplace in general. So it is different, imo, than someone who just stopped working and is trying to go on claim. But that is a question and argument for his lawyer, not his agent.

 

[Rosegarden]

Thanks everyone for the replies. Yes, it seems like not an easy thing to predict what might happen. Yankee466 - this policy was written in the 80’s and does seem pretty remarkable it originated with Crowne Life I think and was endorsed by a dental society. Benefitbperiod for illness was lifetime and a lifetime sickness rider was added. I’ve tried to help by doing research. I have seen a lot saying income level does matter - maybe not an exact match but 60-80% of pre-disability income which for a medical professional can still be very high. Interesting point though about not having been a dentist for 20 years. I’d think that would make it hard to teach.

 

[Gilbert07]

Yes, you are right; long-term disability benefits the sufferer by providing financial assistance. As 60-80% of pre-disability income is not much sufficient to maintain a life in the society. It will be difficult to cover the medical expense along with the daily life routine