Glossary of Disability Insurance Terms: What They Really Mean for You
Private, for-profit corporations generally deliver individual and group long-term disability insurance benefits. Thus, every disability insurance policy contract is ultimately designed to protect the issuing disability insurance company’s bottom line.
Essential disability benefits are the same under most individual or group long-term disability insurance plans—that is, you should receive income-replacement payments if you are sick or injured and rendered disabled. In addition, each individual or group long-term disability insurer will draft the contractual language controlling your disability benefits in a way that saves it the most money. Accordingly, essential terms like disability and income don’t always mean what you think, or what the dictionary says.
Moreover, individual and group disability insurance policies are seldom written in a way the average person can understand. Instead, lawyers draft these disability contracts in convoluted, confusing language, with the goal of limiting your right to individual or group long-term disability benefits.
Many claimants who believe they qualify for individual or group long-term disability benefits are shocked to find out they don’t have a disability as defined by their individual or group disability insurance policies. Many other claimants believe the opposite. You may assume a broken wrist doesn’t qualify as a real disability, but it may—depending on your occupation and your specific individual or group disability insurance policy.
Don’t let the confusing legal language in your long-term individual or group disability insurance policy scare you. The award-winning individual disability lawyers and group ERISA attorneys at DarrasLaw are here to help. At DarrasLaw, we have more then 100 years of combined litigation and claim experience fighting America’s largest disability insurance carriers—and winning. Our top-rated ERISA attorneys and individual disability lawyers know the tricks that individual and group long-term disability insurance companies will use to wrongfully delay, deny, and terminate your valid claim.
The team of top-rated ERISA lawyers and individual disability attorneys led by nationally renowned disability lawyer Frank N. Darras provides free disability policy analysis and free claim consultations to help you understand your rights and your disability benefits. Call us today at (800) 458-4577 or write to us online.
Commonly Misunderstood Terms in Individual and Group Long-Term Disability Insurance Policies
When you think of the word disability, what comes to mind? Blindness, amputations, paralysis, traumatic brain injuries?
Instead, you may have a qualifying disability under the terms of your individual or group disability insurance policy if you are recovering from surgery, or suffer from persistent migraines, depression, broken bones, Lyme disease, arthritis, asthma, or pregnancy complications, among many other sicknesses or accidents.
You will find the following common terms, each with unique and specific legal definitions, in most individual or employer-sponsored ERISA disability insurance policies:
- Disability – Generally defined as when a individual or employee is both (1) unable to perform the important duties of his or her regular occupation as a result of a qualifying injury or illness or (2) cannot earn a certain percentage of his or her income working in his or her regular occupation.
- Pre-existing condition – An injury or illness for which you either (1) sought treatment or (2) reasonably should have sought treatment within a specified period prior to your disability insurance’s effective date. This timeframe will vary depending on your individual or group long-term disability insurance plan language.
- Employee – Someone insured under the disability plan.
- Injury – Accidental bodily harm, whether an injury or illness, resulting directly and only from a qualifying accident. Depending on the policy’s language, for example, if you were injured while uninsured and then reinjured the same weakened area, your long-term individual or group disability insurance company may deny you disability benefits.
- Physician – A licensed doctor rendering only that treatment most appropriate for your condition within the scope of his or her license who is not your spouse, your immediate family member or in-law, or a person living in your household. Accordingly, if you are required to submit an attending “physician’s statement” in support of your valid disability claim, it won’t be considered a “physician’s statement” if it comes from your sister-in-law, even if she’s a medical doctor.
- Regular occupation – The occupation in which you were working when you became disabled. Occupation in group ERISA policies is generally defined by how that work is performed nationally, not by the tasks you are specifically instructed to perform in the course of your occupation for your specific employer. Some individual and group disability insurance policies, however, may define your regular occupation as the occupation and tasks you specifically perform for your employer. This definition can prove crucial in your fight for individual or group long-term disability benefits. For example, let’s say you are an accountant, but you provide concierge services to your clients by driving to their homes and offices and carrying heavy files. If you break your leg and can’t perform that task, which most accountants around the country do not ordinarily do, then your eligibility for individual or group long-term disability benefits will hinge on the definition of this term.
These are only a few examples of how certain terms are defined by individual and group disability insurance companies in ways that differ from how most people use them in day-to-day life. Understanding these terms before you file a valid claim for individual or group ERISA long-term disability benefits is essential to protecting your legal rights.
Disability Insurance and Contract Law
Although a complex set of federal laws called the Employee Retirement Income Security Act (ERISA) generally governs employer or group-sponsored disability insurance policies, your policy language still controls your right to your or group disability benefits.
Understand your policy and your consumer rights before filing a valid claim for individual or group long-term disability benefits. Our experienced ERISA lawyers and award winning individual disability attorneys at DarrasLaw can review the terms of your disability insurance policy, help you understand your rights, and recommend claim suggestions to enhance your valid claim.
For example, if your long-term group disability benefits will pay you less than you need to get by, you may consider purchasing an individual disability insurance policy from an agent or broker to supplement your income if you become disabled. These individual disability insurance policies are not generally governed by ERISA’s onerous restrictions, and if you paid the premiums yourself, the benefits generally flow tax-free.
Call a Top-Rated Individual Long-Term Disability Lawyer or Award-Winning ERISA Attorney at DarrasLaw Now
Whether you have already applied for individual or group disability insurance benefits, were wrongfully delayed or denied coverage, or are concerned about a potential pre-existing condition, call DarrasLaw today. We charge nothing to review your individual or group long-term disability insurance policy. DarrasLaw can help you understand your legal rights, and explain how your policy defines complex disability terms. Furthermore, DarrasLaw’s top-rated ERISA lawyers and award-winning individual disability insurance attorneys can discuss your employment history and how that might affect your claim as well as review your medical records and advise you as to how best to proceed with a valid claim.
When it comes to the legal terms and conditions used in your individual or group disability insurance policy, don’t trust common sense or dictionary definitions. Instead, contact DarrasLaw’s award-winning individual long-term disability insurance lawyers and nationally renowned group ERISA attorneys today, online or at (800) 458-4577.