Disability Plan Terms and Definitions - FAQ

This is variously defined in different policies. It usually involves a condition for which you received medical care or consultation during a stated period of time prior to the effective date of your insurance coverage. Medical care usually includes the use of prescription drugs and physician consultations and services. Disability plans usually exclude or limit coverage for that medical condition for a specified time period.

"You are considered totally disabled if, due to sickness or accidental bodily injury, you are unable to perform the material and substantial duties of your occupation."

"The inability to perform the material and substantial duties of your regular occupation, the insurance company will consider your occupation to be the occupation you are engaged in at the time you become disabled, they will pay the claim even if you are working in some other capacity.

"You are totally disabled, if solely due to sickness or injury, you cannot perform the material and substantial duties of your regular occupation and you are not working in any gainful occupation." This definition is typically used to reduce benefit payments to someone who is disabled from their occupation but chooses to work in another occupation.

"You are considered totally disabled if you are unable to perform the material and substantial duties of any occupation for which you are reasonably fitted by education, training, or experience."

"Because of sickness or injury you are unable to perform the material and substantial duties of your occupation, and are not engaged in any other occupation."

"a total disability, which is a medically determinable physical or mental impairment which renders the Participant incapable of engaging in any substantial gainful employment activity productive in nature, provided that the Plan Administrator finds, and a physician or physicians designated by the Plan Administrator certify, that the Disability is likely to be permanent during the remainder of the Participant's life."

"You are considered partially disabled if, due to sickness or accidental bodily injury, you are unable to perform the material and substantial duties of your occupation on a full-time basis, but can work at your own occupation on a part-time basis or at another occupation on either a full- or part-time basis."

"The result of an illness or injury which prevents an insured from performing one or more of the functions of their occupation."

"A condition in which, as a result of injury or sickness, the insured cannot perform all of the duties of his occupation but can perform some. Exact definitions vary from policy to policy."

"A disability that prevents an insured from engaging in some of the duties of his or her usual occupation or from engaging in the occupation on a full-time basis."

Residual disability provisions, if provided in the policy, cover those who have begun to recover from total disability but continue to have limitations. Residual disability may be defined as an inability to earn your former salary (usually below 80%) or an inability to work full time or perform the same duties you performed prior to illness.

The elimination period is a waiting period to determine that you are truly disabled. It usually ranges from three to six months.

Most group disability plans reduce their benefit payments by "offsetting" other income you receive. Typically you will be required to pursue any benefits or compensation from other sources, including workers compensation benefits, social security disability benefits, retirement benefits, money received from a third-party lawsuit, money you receive from a personal insurance policy, and money you earn for any work you do while disabled from your job.

In recent years many group disability plans have instituted a two-year limitation on benefits to individuals who are disabled by mental and nervous disorders. If you are subject to this limit, your payments will cease after 24 months, regardless of your medical condition. Frequently the disability insurance company will try to define a physical disability as a mental and nervous disability subject to the limit. If you have a physical disability and are also depressed as a result of being disabled, you must make sure your doctor clearly indicates that you are depressed secondarily and as a result of your physical disability. If the depression is put down merely as a second reason for your disability, the insurance company may try to apply the two-year limit.