Disability Defined: how to Qualify for Disability

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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UPDATED: Jul 16, 2021

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Qualifying for disability insurance depends on how your policy defines being disabled. Although some policies will limit your benefits based on how you sustained an injury, the injury itself is typically what qualifies you for disability benefits. Make sure you understand how your policy defines disability, and what you need to show in order to qualify for benefits.

Different Standards of Qualifying for Disability

The definition of disability used in insurance policies can differ, and depending on how easy or hard it is to qualify for disability benefits, your premium could be higher.

  • Some policies consider you disabled and will pay benefits if you are unable to perform the duties of your regular occupation. For example, if you are a radio talk show host and you contract esophageal cancer that prohibits you from speaking, you would qualify for disability benefits. In this instance, the definition of disability can be easy to meet because, although you can no longer do radio shows, you can perform a variety of other jobs.
  • Some policies use a different definition of disability that states that you only qualify for disability if you can not work any gainful employment. For example, if that talk show host can no longer be a talk show host, but does have the ability to produce radio shows, he would not qualify for disability benefits because he can engage in some kind of gainful occupation–just not his current occupation. This definition of disability is harder to satisfy, and these policies can be cheaper.

TIP: Make sure you understand your policy’s definition of disability and that you are comfortable with how you will qualify for your disability benefits.

Qualifying for Disability under Presumptive Disability Clause

There are some disability policies that have a presumptive disability clause. This clause will allow you to immediately qualify for disability if you suffer certain injuries. The best part about a presumptive disability clause is, in many cases, the insurance company will allow benefits to begin immediately, waiving the standard elimination (waiting) period. You also would not be required to have periodic medical examinations to prove continuing disability. The most common conditions that meet the requirements of presumptive disability under this clause are:

  • Loss of eye sight
  • Loss of hearing
  • Loss of use of two or more limbs

TIP: Most policies include a presumptive disability clause in their basic coverage. Ask your agent if your policy includes this clause and review any specifics of this coverage to understand when you would qualify for disability under this clause.

Qualifying for Disability Residual Benefits

If you are able to work, but your income is reduced because you cannot fulfill all of your job responsibilities, residual benefits help to make up the difference in your income. A residual benefit allows a partial disability payment based on the percentage of your loss of income. In some policies, you do not need to be totally disabled to qualify for disability under residual benefits.

TIP: Receiving partial benefits is not available under all policies, so make sure you include this feature at the time of purchase if you are interested.

Qualifying for Disability: The Nature of Your Injury

The best disability insurance policies do not limit coverage to certain types of injuries. When choosing disability insurance coverage, look for a policy that provides coverage in the event of accident ,i>and/or illness. Since you do not know what could cause you to become disabled—debilitating illness, car accident, work injury, etc—having a policy that will cover all possibilities is the best way to protect your family’s financial future in the event you become disabled.

A policy that covers you for accidents is not limited to accidents that happen at work, but includes injuries suffered while engaging in a hobby. If the injury does not allow you to perform the duties of your own occupation or leaves you unable to perform any gainful employment, then you would qualify for disability regardless of how you got hurt.

Most disability policies have exclusions that will limit coverage. Examples of when a disability policy will NOT pay are:

  • Any disability suffered while incarcerated.
  • Any disability caused by, contributed to, or which results from the suspension, revocation or surrender of your professional or occupational licenses or certification.
  • Any normal pregnancy or childbirth during the first three months of total disability or the eliminations period, if longer.

Check your disability policy for exclusions to see when you WOULD NOT qualify for disability benefits under your policy.

Understanding how you qualify for your disability benefits is the best way to ensure you are purchasing the right type of policy. When you are ready to compare disability policies before you buy, click here for a free disability insurance quote today.

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