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Individual Disability Insurance:
As the name suggests, individual disability
insurance policies are purchased by individuals directly from
the carrier and provide long-term disability benefits in the
event of sickness or injury. Individual polices fall into
two categories: "general" and "occupational."
A "general" disability policy insures against sickness
or injury that precludes the insured from performing all work
while an "occupational" policy provides relief if
the insured cannot perform the material and substantial duties
of his or her own occupation. Thus, an "occupational"
policy will provide greater coverage to the insured, who will
be entitled to benefits even if he or she is able to engage
in another occupation. Individual policies usually provide
coverage in set amounts, e.g., $5,000 per month, rather than
as a percentage of the insured's salary.
Group Disability Insurance:
Group disability insurance polices are made
available to participants of organizations, such as members
of the American Medical Association. Unlike most individual
policies, group policies typically confer benefits calculated
as a percentage of the insured's base salary, usually from
50-75%. These policies may limit the maximum amount of benefits
payable, e.g., no more than $5,000 per month, regardless of
base salary. Further, group policies often reduce benefits
when the insured receives income from other sources such as
Social Security disability benefits or worker's compensation.
Employer-Sponsored Disability Insurance:
Employer-sponsored disability insurance policies
are typically the least expensive policies and are similar
to the "group" policies described above, providing
employees with disability insurance based on a percentage
of their base salary as part of the employer's overall benefits
package. Unlike group policies, however, employer-sponsored
policies are governed by the Employee Retirement Income Security
Act of 1974 (ERISA), which has significantly affected the
administration and litigation of disability insurance claims.
Unfortunately, ERISA deprives insureds of significant rights
to which they would normally be entitled under state law.
These include the right to a trial by jury and the possibility
of punitive damages where the carrier has acted unreasonably
or maliciously
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