Insurance Cost

What Is A Disability? Who Defines Disability?

There are several definitions of "Disability" within a disability insurance policy, therefore there are several ways you can be disabled under the terms of the contract. To answer your question in a simple fashion, a disability is a sickness or injury which interferes in your ability to work. Hopefully this answers your first question, "Does this policy cover accident and sickness?" with a resounding yes.

Possible Disability Insurance Claims

1. Totally Disabled - The definition of total disability is pure own-occupation for all attorneys. Because of sickness or injury you are unable to perform the material and substantial duties of your regular occupation, or occupations if more than one, in which you are engaged at the time of disability. A Specimen Policy is available for your review as well.

2. Residual Disability - A residual disability can be thought of in two different claim scenarios. Think of a residual disability as a partial disability, or as a recovery benefit. For attorneys who run their own practice or are the chief rainmaker for their firm, there must be a residual rider in your policy that will compensate you purely on income loss following a disability. Thus, if you return to full time work and have to rebuild your practice (although you're phsyically recovered and no longer technically disabled) benefits will continue until your income has been restored.

3. Presumptive Disability - Should you suffer the total and complete loss of hearing, speech, sight, or the use of any two limbs the insurance company will pay you first day benefits. In other words, you do not need to wait through the elimination period before you become eligible for monthly benefits if you suffer one of those losses.

Who Defines Disability?

Reality is that the disability insurance company defines disability, whomever the claims examiner is will make the final decision as to whether or not your sickness or injury falls within the definitions of the policy. Typically if the physician treating your accident or illness states that you are unable to perform the material and substantial duties of your regular occupation, the claims examiner will use that for a claims determination. However not every claim is cut and dry, and sometimes the disability insurance company will require an independent medical examination to help with the final claims determination. While there are definitive medical tests that can show a claims examiner you just had a heart attack, a stroke, cancer, or diabetes complications, there are some disabilities that are not so easy to verify such as depression, anxiety, and stress disorders.

The bottom line is if your injury or illness falls within the definitions of the disability insurance policy, then you are disabled.