While a car accident itself may not be a reason to file a disability claim, many disability claims result from injuries sustained in a crash or other type of accident. While you may not qualify for Social Security Disability Insurance if the injuries don’t totally incapacitate you for more than 12 months, many individual and group long term disability policies cover the inability to work due to these incidents as well as almost all short term disability policies. From back problems to broken bones to “whiplash,” there are many different types of injuries that can result from even seemingly minor vehicle accidents, including some that may not become apparent for an extended period of time. Today’s blog post is going to review some of the different types of injuries that may result from these accidents and how to obtain the disability benefits you deserve while recovering from these injuries. Continue reading
Deciphering the different definitions of disability is a surprisingly complicated process. Some of these definitions can be found in almost every policy, while some use attachments or riders to tweak the policy language. While the exact terminology may be different, there are five basic definitions of disability that are important to understand if you’re considering filing a claim for benefits or even if you’re just trying to decide what type of coverage to purchase.
- Own Occupation. Simply put, this definition defines you as totally disabled if you can no longer perform the material and substantial duties of your occupation. Some policies will even consider you totally disabled if you are unable to perform just one of the material and substantial duties of your occupation. If you are being paid benefits under an own occupation disability policy, you may be able to go back to work in a different type of job and still be entitled to benefits as long as you’re unable to perform the job from which you were declared totally disabled. Because of this liberal definition, these policies are usually more expensive and harder to obtain.
- Any Occupation. This definition is almost the opposite of Own Occupation. You’re only considered totally disabled if you cannot perform the duties of any occupation. Usually, the policy will include language that takes into consideration your education, training, experience, and earnings level as well. This prevents the insurance company from trying to envision you in a job for which you’re under-qualified or over-paid just to end your claim. This definition is often found in cheaper, group policies and can be challenging to collect benefits without strong medical evidence and very debilitating conditions.
- Split Definition Coverage. While this isn’t a definition of disability in and of itself, this definition is very common in disability insurance policies so it’s worth discussing. Many policies have definitions of disability that switch from Own Occupation to Any Occupation after a period of time that can range from 6 months to 5 years. Anyone receiving disability benefits under this type of coverage should be extremely wary leading up to this transition date, as insurance companies often plan for how to stop paying benefits around that time.
- Presumptive Total Disability. Regardless of your policy definition of disability, certain catastrophic injuries or illnesses are automatically considered totally disabling. These often let you skip some of the requirements that must be met to be considered totally disabled. You’re allowed to receive benefits immediately after the elimination period that will continue even if you return to work. The medical events that fall under this definition include the loss of sight in both eyes, loss of hearing, loss of speech, the use of both hands, the use of both feet, or the use of one hand and one foot. These losses must be complete. Different policies can have slightly different qualifications for Presumptive Disability and not all of the ailments listed above will qualify under every policy.
- Residual Disability. The first four definitions have been about Total Disability, but this isn’t the only way to qualify for benefits. Some policies include definitions of disability that will pay you a portion (or all) of your benefits if your work level and/or earnings are reduced. Under Residual Disability, claimants are paid benefits based on the relative amount of income they’ve lost due to their disability. This is calculated through a formula that takes into account the disabling condition and the percentage of pre-disability income the claimant continues to earn. Be aware – some cheaper policies include a clause that requires the claimant to have been totally disabled for a while before they’re able to collect residual disability benefits. There are two ways to purchase Residual Disability coverage: you can either purchase a Total Disability policy with a Residual Disability rider or you may purchase what is often called an income replacement policy. Income replacement is another term for residual coverage and can be the cheaper of the two option since it lacks specific Total Disability coverage.
- Partial Disability. This definition is very similar to but slightly different from Residual Disability. The main difference is that Partial Disability does not consider the loss of income calculations when determining the benefit amounts. Rather, if you’re considered partially disabled, the policy will pay you 50% of the total disability benefit amount. Partial Disability is also not offered as a standalone policy and is either included as a rider to a policy or as the base coverage in some rare policies. Benefits periods for Partial Disability are often much shorter, usually not extending beyond 6 to 12 months.
Even if your injury or illness may fit into one of these policy definitions, it doesn’t always mean you will receive benefits. There are many other policy considerations, such as appropriate care or diagnosis limitations, that can decide whether or not you’ll be able to collect your benefits. If you’re considering filing a disability claim and are not sure of the definitions in your policy, or if you’re not sure if you qualify for benefits under your policy’s definition, please call our firm toll-free at (855) 828-4100 or sign up for a free consultation on our website. We can help you get the answers you need to get the benefits you deserve.
We have encountered several cases where claimants have been denied their benefits not because of incomplete or inconclusive evidence of their medical conditions but solely because their conditions kept them from working longer than the guidelines used by disability insurance claim departments. When evaluating disability claims, claims examiners rely on industry developed resources to determine the expected duration of the claim, regardless of the specific circumstances. Based on these claim management practices that have been put into place by most insurance companies, we’d like to shed some light on the process used to assign expected return to work dates for claims and the extra steps that claimants need to take to protect their benefits if they’re disabled beyond these arbitrary dates. Continue reading
What a difference a year makes! Where does the time go?
We’ve been writing articles for this blog for over a year, and we’ve learned as many things from our readers as we hope you’ve learned from us. As our topics have grown and more readers have found us, we wanted to make sure that some of our posts don’t get lost in the noise of the Internet and buried deep away where claimants would less likely be able to find help. In the spirit of the NCAA basketball tournament, we’re going to go through our most popular blog posts as well as highlight some posts that we think include topical, valuable information that may be helpful in your disability claim. Thanks again for reading our blog over the past year and making us one of the top-rated destinations for disability claim advice and help. While we hope you never have any problems with your conditions or your claim, we’ll continue to be here to read, just in case, for years to come!
One of the biggest issues our clients face when filing their disability claim is the lack of clear medical opinions explicitly linking their condition to their disabling restrictions and limitations. Physicians are skilled at diagnosing a disease or illness, but they may not be the best at explaining why the condition is disabling for the claimant. This can especially be problematic with mental illnesses or other types of invisible disabilities. Any ambiguities cause increased scrutiny and in-house referrals by claim examiners and are often used as a basis for a disability claim denial. Helping your doctor connect the dots between your condition and your inability to work smooths the disability claims process and fosters a quicker claim approval with fewer questions. We’d like to discuss two perspectives to this issue: the claimant’s and the physician’s. We’re going to discuss what each party can do to make the disability clearer and the claims process smoother. Continue reading
Chronic pain is a condition that presents a challenging claim scenario because of the difficult nature of the diagnosis, the many testing options, and the wide variety of treatment plans prescribed by physicians. Each of these factors relate to one another in a disability, and all need to be well documented in a disability claim. However, this does not mean that you have to blindly follow a physician’s treatment plan. There are many alternative treatments that are safe to use in conjunction with your recommended care and treatment and will help reduce the stress and suffering caused by chronic pain syndrome. Alternative treatments are common among our clients, so we’d like to mention the three most often used alternative treatments. Therapies and results vary from person to person, and what works for one individual may not work for another. Before starting any alternative course of therapy, please do prudent research to allow you to discuss it with your treating physician. Most importantly, never abandon a treatment plan prescribed by your doctors. Research and discuss alternatives to be an engaged patient but don’t abandon it. Continue reading
The new year is always a good time to review the events of the past 12 months and see what you can do to improve your life over the next 12 months. If you’re dealing with health problems and a resulting disability insurance claim, this is also a great time to review the status of your claim and find ways to make the claim process stronger, simpler, and better. This can be done in whichever stage of the claims process you’re in. Whether you are still considering filing a claim, are waiting on a decision from the insurance company, are receiving benefits, or are facing a claim denial, it’s important to stay on top of your claim. Insurance companies are always looking for new strategies to increase profits and reduce claims, so you should always try and stay one step ahead of them. These 10 ways to protect your claim can help reduce your stress and work required on your disability claim over the next 12 months. Like most things, maintaining a strong disability claim is easier than rehabilitating a claim when it breaks (or is denied). Continue reading
June is National Migraine Awareness Month, and we would like to recognize this by discussing a few current news articles and events surrounding migraines and how this misunderstood affliction affects our readers who suffer from migraines. Migraines are very common in the United States, with the World Health Organization estimating that 37 million people suffer from them. This includes 17 percent of women and 8 percent of men in the U.S. that experience some form of the condition. Caused by many different triggers, there is no singular definitive cause for migraines, but many studies and tests increasingly point to types of hyperactivity in the brain. New studies are beginning to shine some light on the causes of these debilitating headaches and how people can help mitigate the effects of migraines and continue to successfully contribute in their careers. Continue reading
There are many different definitions of total disability, all of which depend on the language in your disability insurance policy. For a disability claim to be paid, your disability must meet the exact definition in your insurance policy. Different policies can have different terms, so you can conceivably be totally disabled under one policy but not the other. And public disability insurance – Social Security, state, and/or the VA – have completely different definitions and criteria.
In this post, I am going to give you some commonly used terms and what they mean for your claim. Your specific disability insurance policy may offer variations of these definitions.
Own-Occupation Disability Insurance
Called Own-Occ, this is the most comprehensive definition of total disability: the inability to perform the material and substantial duties of your occupation. Your occupation is separately defined, usually as the duties you were performing at the time of disability. There is usually a requirement to be receiving appropriate medical care and treatment as well. Own-Occ allows you to continue or resume working in a different occupation and still be paid disability benefits.
Income Replacement Disability Insurance
Insurance companies that don’t have own-occ plans will often offer income replacement. While income replacement plans seems similar to own-occ, they have a major difference: you cannot earn income from any occupation and still receive disability benefits. Under this type of plan, your disability claim benefit checks will be reduced if you go back to work in any capacity.
Any Occ and Gainfully Employed
These terms are the most common and are often used in group Long Term Disability (LTD) plans. Any-Occ disability is usually defined as a sickness or injury that prevents the individual from performing any occupation that the insurance company deems the individual is reasonably qualified. Gainfully employed sets a threshold that you can return to work but can only earn an income much less than your disability benefits. Filing a disability claim under this type of coverage has many subtle areas where the insurance company can deny your claim.
So…Do not assume anything when it comes to your disability insurance and read your policy carefully, word by word.
No matter what type of coverage you may have, you should always be aware of your exact terms and definitions and how different circumstances may affect your claim. When filing your disability insurance claim, you want to make sure the insurance company has no reason to question and delay your benefits, as this will lead to a long, arduous process and cause unnecessary stress and worry – when you’re already disabled! For further information or comments, please feel free to leave a comment on the blog, or visit our website at www.RoyalClaimsAdvocates.com.