Material and Substantial Duties

In own occupation policies, this term is typically used to describe the key/characterizing duties of your occupation or specialty. Many individual policies will consider you totally disabled if you are unable to perform these duties.

Click here for more information about how “material and substantial duties” are used to define total disability.

Medical Examination

When you apply for disability insurance, many companies require a medical report and/or examination.  The insurance company then reviews this information to see if you are suffering from any conditions that could potentially cause a future disability.  If you are, the insurance company will likely add a rider to your policy that specifically excludes the reported conditions from coverage under your policy.

Mental Disability

Mental disorders, such as severe depression, anxiety, PTSD, etc., can cause total or partial disability.  Whether or not you will be able to collect disability benefits as a result of a mental condition depends on several factors, including the terms of your policy, the nature of the mental condition, and the duties of your prior occupation, among other things.  

Insurers often deny mental disability claims on the ground that the claimant’s subjective symptoms do not provide objective, verifiable evidence of disability.  In addition, even if your claim is approved, the amount of time that you are able to receive benefits may be drastically reduced if your policy contains a mental illness limitation provision.

Click here for more information about mental illness limitation provisions and the unique challenges of mental disability claims.

Mental Illness and Substance Abuse Limitations

Many policies—especially group policies and employer-sponsored plans—limit the period of time that you can collect benefits if your disability is caused by a psychological, behavioral or emotional disorder and/or substance abuse.  Typically, benefits are limited to a period of 24 months, unless the insured is confined to a hospital.

Click here for more information about mental disorder and substance abuse limitation provisions.

Minimum Monthly Benefit

Some policies—most often group policies and employer-sponsored plans—contain offset provisions that reduce your total monthly benefit if you are receiving benefits from other sources, such as Social Security disability benefits or Worker’s Compensation benefits.  Typically, these policies will also contain a provision that states the minimum amount you will be paid as a monthly benefit, regardless of the total amount of your other income benefits.  The minimum monthly benefit amount is typically a very small fraction of your total benefit amount.

Click here for more information about how offset provisions can reduce your monthly benefits.

Musculoskeletal Conditions

Injuries and disorders that affect the musculoskeletal system. Common examples include carpal tunnel syndrome, thoracic outlet syndrome, degenerative disc disease, and herniated discs. These can be caused and/or exacerbated by repetitive motion and stress, such as that required in clinical dentistry and other surgical professions.

Click here to learn more about why disability claims based on musculoskeletal conditions are often targeted for denial/termination.