Clarity is critical in the world of contracts and obligations. When it comes to disability insurance, the insurance company typically makes use of one of two main definitions of disability in their contracts: total and partial. Most importantly, should you ever need to claim long-term disability benefits the wording in your contract will guide the claims process.
The definitions of disability can vary from policy to policy, even under the same common terms like ‘total disability.’ While it is always important to understand a policy before signing it, many individuals who need to make a claim later on will find themselves unprepared or confused about their coverage.
Here, a lawyer specializing in long-term disability will explain things clearly and put matters in context. They will also work with a person’s treating practitioners to ensure the proper disability test – the one listed in the policy – is used. This way the legal-medical team can work together to compile the most compelling and detailed claim possible.
While definitions change, total disability generally refers to an inability to regularly perform the duties required of a person’s current occupation (their job up to the point of injury or illness). This accounts for the ‘own occupation’ portion of coverage, which typically pays out 60 to 70 per cent of income prior to injury, up to a stated maximum. The ‘own occupation’ benefits commonly stay in effect for the first two years, before the ‘any occupation’ definition applies, which is a more stringent definition of ‘total disability’.
As the term suggests, partial disability is a less destructive and inhibiting form of impairment. But that doesn’t mean it shouldn’t be seen as serious. Here, too, definitions vary by policy including in percentage of payout and length of benefits. The definition covers reduced earning potential, say, when the injured person can work only reduced hours or can’t perform a key aspect of the job. The policy will spell out the percentage of income that is lost in order for benefits to apply.
If you’ve been denied long-term disability benefits, an experienced personal injury lawyer at Futerman Partners LLP can help you decipher your coverage and work to secure the right benefits. Visit www.futermanpartners.com to learn more.