Termination of Benefits

Insurance companies can pay a claim for years, only to decide that an insured is no longer eligible for benefits. Signs that your long-standing claim may be targeted for termination include an increase in the frequency of requests for claim forms, a request for an independent medical examination or functional capacity examination, a re-assignment of your claim to a more senior claims analyst, and/or conducting surveillance, among others.

Click here for more information on disability claim denials and terminations.

Total Disability

The definition of “total disability” is one of the most important terms in your policy.  This is the definition that you must satisfy in order to receive the full amount of your monthly benefits.  Generally speaking, a claimant qualifies as totally disabled if, due to sickness or injury, he or she is unable to perform the substantial and material duties of his or her occupation, is not engaged in any other occupation, and is under the care of a physician for the sickness or injury.  However, there is a wide range of “total disability” definitions, so you must check your policy to determine the precise requirements that you must satisfy to qualify for benefits.

Click here for more information about the different types of “total disability” definitions that are used in disability insurance policies.

True Own Occupation Policies

These policies provide the best own occupation coverage because they allow you to collect total disability benefits even if you are working in another occupation, as long as you are unable to perform the material and substantial duties of your prior occupation. Many physicians and dentists believe they have this type of policy, and are surprised to learn that there are several different types of “own occupation” policies that are not “true own occupation” policies.

Click here for more information on the several variations of own occupation policies.