Many policies distinguish between a disability caused by injury versus one caused by illness/sickness. Disability due to illness is typically defined as a sickness or disease that firsts manifests itself on or after the effective date of a policy, while it is in force. Under some disability policies, the amount and duration of benefits is determined based on whether a disabling condition is classified as an injury or as an illness.
Click here to learn more about how your policy may treat disabilities due to illness different than disabilities due to injury.
In-House Medical Consultant
These are doctors who are paid by the insurance company to review your medical records and look for ways that the insurance company can deny your claim.
An incontestability clause precludes insurance carriers from inquiring into representations made on the policy application once the policy’s incontestability period has lapsed. Typically, the incontestability period will last for two years from the effective date of the policy. Once this time period has expired, the insurance company loses the ability to rescind the policy based on representations made in the policy application’s paperwork.
Click here for more information about incontestability clauses.
Independent Medical Exam (IME)
An IME is an exam conducted by a doctor to verify whether you are truly disabled under your policy’s terms. Insurance companies often require claimants to undergo IMEs in the hopes that they will be able to use the IME results to deny or terminate benefits. Although IMEs are supposed to be “independent”, the doctors performing them are almost always selected and paid by the insurance company, and many insurance companies use the same IME doctors over and over again, because they know that those doctors will generate reports that favor the insurance company’s interests.
Click here for more information on IMEs.
Individual Disability Insurance Policies
Individual policies 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.
Click here for more information about different provisions that can be included in individual disability insurance policies.
Many policies distinguish between a disability caused by injury versus one caused by illness/sickness. Disability due to injury is typically defined as accidental bodily injury that occurs on or after the effective date of the policy, while it is in force. Under some disability policies, the amount and duration of benefits is determined based on whether a disabling condition is classified as an injury or as an illness.
Click here to learn more about how your policy may treat disabilities due to injuries different than disabilities due to illness/sickness.