There are a number of different types of disability insurance plans. Some short terms, some long term, and each with a variety of different terms and conditions. However, there are some common features of disability insurance plans. First, disability insurance plans are issued by a private insurer, and should not be confused with Social Security Disability Insurance (SSDI).

Social Security Disability Insurance is a program offered by the federal government that covers disabled individuals. Private disability insurance is provided either by direct purchase or through your employment as part of a benefits package. Private disability insurance is also not to be confused with workers’ compensation, which is a state mandated program that covers injuries or illnesses arising out of workplace injury and covers medical bills and wage replacement. Private disability insurance, whether long term or short term, is a contract between a private insurer and an individual or a group (employer provided), which pays a set amount of benefits if you become ill or injured, such that you can no longer perform your job. Tell a Columbia personal injury attorney about what you are going through.

Different types of private disability insurance plans have different terms. Some plans are written specifically for a particular job or profession. If you become ill or injured and are unable to continue your specific job or profession you are considered disabled and will be entitled to the benefits. Sometimes these policies have a provision like this, but it is limited for a period of years, for example 5 years, after which you must be disabled from any employment to continue being disabled. However, a majority of plans require you to be disabled from any full time gainful employment, and many are limited to specific occupations held prior to disability.

Short term disability coverage is a temporary disability benefit usually lasting between six months and one year. An insurance policy may have both short term disability coverage and a long term disability benefit, or you may have more than one policy. Long term disability insurance coverage provides benefits for a longer term, usually 5 years or up until an age closer to retirement. Most policies end around age 65, but individual policies can go longer, depending upon the individual terms of the policy.

Disability policies are sold with different terms and conditions. Common differences between policies are those that are “occupation specific” or “any occupation”. You should ask the agent which sort of policy you are purchasing. As the terms imply, occupation specific usually refers to the fact that if you are disabled from your specific occupation then you will be considered disabled. Any occupation policies require that you be disabled from any occupation before they will pay benefits. It is also important to be aware of the specific terms that apply to these general descriptions.

For instance, even occupation specific policies, such as one for a physician, can vary greatly. A physician may believe he has an occupation specific policy because it is for a doctor. However, a cardiothoracic surgeon would want an occupation specific policy for cardiothoracic surgeons, not any physician, because if he could no longer be a surgeon because of a disability, he may still be able to function as a clinician who would make substantially less. Therefore, the cardiothoracic surgeon needs an occupation specific policy that is explicitly specific to his profession to be adequately protected.

Yes. Typically, disability policies will have specific illness or impairment exclusions where they will provide no coverage. You should ask the agent at the time of sale for a specific copy of the policy that will be issued, so you can satisfy yourself as to the illnesses or impairments that are excluded.

“Own occupation” means that you are not able to perform the substantial material responsibilities of your occupation at the time you became disabled. If you cannot perform those responsibilities in the usual course of your business because of the disability covered by the policy, then you may be disabled.

Substantial and material duties of your occupation are meant to encompass the scope of your work. There is no specific test to determine those duties or your ability to perform them. This analysis will be based upon the facts. However, an insurer cannot deny a claim if a person cannot perform the duties because of the physical restrictions, or as a result of pain. Thus, while you may be able to continue your work, but you are in great pain, you would qualify as being disabled as long as the pain was medically diagnosable.

Modified own occupation disability policies are policies in which you are protected from disability in your own occupation for a term certain of years less than your full work life. Thereafter, they convert to any occupation policies.

The fact that your employer provided your disability coverage most likely means that it is governed by the Employment Retirement Income Security Act of 1974 (ERISA). ERISA is a federal law that applies to most employee benefit plans that are not provided through government plans, unless you are employed by a governmental entity. There are also other accepts that may prevent your particular employer-provided plan from not coming within the terms of ERISA. This is one of the reasons it is important to have an experienced attorney handle your claim.

If your claim is governed by ERISA, then the claims process and decisions of people making the claim are entitled to significant deference by the courts. If your claim should reach a court it will be reviewed in federal court; generally speaking, it will be reviewed on a limited basis. Therefore, it is incredibly important to retain an attorney early to help you with the claim or any first level denial so that the appeal process is closely followed and all necessary facts supporting the claim are submitted.

The most common standard applied by the courts in reviewing ERISA claims is an abuse of discretion standard, which often results in a denied claim being withheld. Attorneys can be effective in helping you receive the benefits that you are entitled to, if you seek assistance early enough and the claim is properly handled. If you need assistance with an insurance claim provided by an employer, you should contact one of our attorneys immediately.

Whether or not you qualify for disability payments under a short term or long term disability policy depends on whether your injury or illness qualifies for coverage under the specific terms of the insurance contract. Most contracts set forth specifically qualify conditions in the terms of the policy. Generally speaking, these conditions include diseases, disorders, and injuries, including psychological conditions, which lead to significant impairments in daily living and function. If you believe you have a claim for disability payments under the terms of the policy, it is important to follow the claims procedure in the policy closely. An insurance policy is a contract between you and the insurance company, and describes the conduct required of both parties.

The insurer is mandated by law to pay the benefits outlined in the policy if you meet the terms of the insurance contract. Sometimes, claims are denied because a person does not meet the terms of the contact, but often with disability policies it is a dispute of whether or not the illness, disorder, or injury is sufficient to meet the terms of the policy. As you might expect, since insurers save money by not paying a claim, they have teams of doctors and other experts who will provide them with basis to deny your claim. Therefore, it is important to seek expert assistance as soon as you learn of an unfavorable decision on your application for disability benefits.