Last time, we talked about how just having long term disability insurance isn’t enough; your condition has to meet the requirements outlined in your specific policy. The provision we detailed in part one of this series is the definition of disability included in your paperwork. If you can’t meet your policy’s disability definition, you’re not going to qualify for benefits.
But that isn’t the only common provision out there, and today we’re going to delve into the elimination period, earnings caps, and other requirements.
Beyond the Definition of Disability – More Long Term Disability Provisions
Minimum time disabled or elimination periods. This is one of the most common requirements in addition to the disability definition. In order to qualify for benefits, many insurers put a clause in your policy that says you have to remain disabled for a certain amount of time (often 180 days) before your eligibility for long term benefits begins. It is vital that you pay attention to this provision, because in order to get the benefits you need, you’ll have to provide medical documentation proving that you were disabled for this amount of time. Additionally, you need to know the length of the elimination period because your insurer will not provide you with long term benefits until you reach the end of it.
Earnings caps. Another typical provision that can be both good and bad for those with long term disabilities is an earnings cap. An example of an earnings cap may state that you can continue to receive long term disability benefits if you work part-time, but only if the money you earn doesn’t exceed 60% of your previous earnings. It’s nice to be able to make some extra money, but go over that amount and you can lose your benefits.
Ongoing treatment. Certain policies demand that those getting benefits continue to receive regular treatment from doctors. If you stop getting medical help, your benefits stop coming.
Medical or administrative proof. It’s common that a long term disability claimant will need to prove their disability by showing medical documentation, but some policies are very specific in what they will accept – x-rays, blood tests, MRIs, and so on. There are even policies that require claimants to become approved for disability benefits by Social Security before the insurer will pay out.
As you can see, disability laws can be quite complex, and knowing all of these things ahead of time will save you head- and heartache. Next time we’ll continue with more common provisions by discussing policy limitations and appeals, but you can learn more now in our free eBook.