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Disability Income InsuranceDisability income insurance provides a monthly income if you become unable to work because of illness or injury. This insurance coverage ensures that you and your family will be taken care of if there is an interruption in your ability to work. Taking steps now to protect yourself with disability income insurance will help you face the future with greater financial confidence.
Disability Income Insurance: Detailed InformationThis information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions document for questions to ask and for more resources. Disability income insurance provides a monthly income if you become unable to work because of illness or injury. You may be aware that income from work could disappear if it becomes impossible to work for a long period of time -- or even permanently. Yet, a time may come when you and your doctor(s) believe that not working is what is medically necessary. Taking steps now to protect yourself with disability income insurance will help you face the future with greater financial confidence. If you are feeling healthy, you may not see the importance of exploring disability income insurance at this point. Yet, planning for the possibility of disability is a good idea for everyone, because even if you are not able to work, you still have to pay your monthly bills. Savings can quickly disappear under these circumstances. Disability income insurance coverage ensures that you and your family will be taken care of if there is an interruption in your ability to work. This document provides basic information about disability income insurance including:
Disability Income Insurance Policy Coverage Options The term “disability” is defined differently for medical leave policies by various employers, state leave laws, private disability insurance policies, and government-sponsored programs, such as Social Security benefits. Read each of your policies and any government benefit program summaries carefully before applying for benefits. Understanding programs and insurance policy terms and definitions will help you present your case for benefits in the best way. There are many kinds of disability income insurance policies. Understanding the following four coverage areas will help you identify the policy that best meets your needs: 1. Amount of monthly benefit Most policies have a fixed monthly disability income benefit that will not increase with time. However, you can purchase extra coverage that provides higher benefit payments. A rider is an addition (amendment) to the insurance policy that either expands or decreases the benefits originally provided by the policy under certain conditions. A rider that allows for benefit payments if you could only work part-time is often considered to be one of the most important for a disability income insurance policy. Another important rider is an “additional purchase option” that would guarantee you the right to buy more disability insurance in the future regardless of your health condition. 2. Policy definition of disability Each disability income insurance policy has its own definition of “total disability,” or what qualifies you to collect income replacement benefits. This definition is one of the first things to think about when you are reviewing disability income insurance policies. You need to know how disability is defined by the policy you select and be certain that you will have income replacement benefits if they are ever needed. The categories typically used to define disability income insurance policy benefits are:
3. Waiting period The waiting period or elimination period is the length of time you must be considered disabled, as defined by your policy, before your benefits will begin. This time period can range from one week to two years, and the longer the wait, the lower the cost of the disability policy. 4. Benefit period The benefit period is the length of time you will receive benefits once the policy starts paying benefits. This period can be from six months all the way to the end of life, and depends on what you choose as well as what the insurer is willing to offer. Selecting Disability Insurance Policy Renewal Terms When buying your own disability income insurance coverage, it is important that you understand whether the policy is: Noncancelable: Provides the right to renew policies each year by timely payment of the required premium, typically to age 65. Following a medical exam and the issuing of your disability income insurance policy, the insurance company cannot cancel the coverage or raise your premium. The policy is renewable on exactly the same terms every year. Guaranteed Renewable: Provides protection because the insurer is not permitted to cancel the policy or unilaterally amend the policy during the period that the policy is guaranteed renewable. The policy cannot be canceled as long as the premium is paid on time. However, the insurance company can raise premiums as long as it does not single an individual out, but raises premiums for a whole class of policy holders. For example, an insurer can make a change for all those living in a state or for all of those working in a specified occupation. Policy provisions must be changed with prior written notification to policyholders. Most of the time, disability polices are either guaranteed renewable only, or noncancelable and guaranteed renewable. With a noncancelable and guaranteed renewable policy, the insurance company cannot change any policy provisions and cannot increase premiums as long as the premiums are paid in a timely manner and all underwriting information was truthful and accurate. If there is a significant change in job status, a guaranteed renewable only policy would not work well. For example, if the policy owner worked at a desk job when first purchasing the policy, but then changed occupations and started working in a more risky job, the insurance company could change the premiums. However, with a noncancelable and guaranteed renewable contract, the insurance company could not change the premiums, so this is considered a better option than a guaranteed renewable contract. Avoid “conditionally renewable” policies because the insurer can alter benefits and rates anytime. When selecting a disability income insurance policy, be sure to consider what is best for you in terms of each of the following factors:
Disability insurance provides income replacement coverage (“lost income”) usually equal to a percentage of your base salary. It usually does not cover other types of income such as commissions, bonuses or retirement fund contributions. If the premiums on the disability insurance policy have been paid and your disability meets the definitions in the policy, you should receive regular income payments regardless of the amount of other income or assets. Pre-existing Medical Conditions Although definitions do vary, a pre-existing condition is a mental or physical condition that exists prior to the effective date of insurance coverage. Most plans exclude or reduce disability benefits for any illness or injury for which an individual received medical treatment or consultation within the time specified in the policy before they will be covered under the plan. This exclusion is often defined as any medical condition for which medical care was received three to six months prior to the effective coverage date. More specifically, the pre-existing condition exclusion usually applies to:
Cancer survivors need dependable insurance coverage. As a survivor, you may find it difficult to obtain new coverage if your existing policy lapses. If you are self-employed or are seeking private coverage, you may face high premiums, pre-existing condition exclusions and extended waiting periods for benefits to start. The ability of individuals with pre-existing medical conditions to be insured may vary because of differences in state laws. Some states have laws specifically related to insurance and cancer. For example, there may be a limit on the length of time a person can be denied life or disability insurance based on a diagnosis of cancer. A doctor will likely need to certify that the cancer has not recurred in the applicant before the policy is approved. Types of Disability Income Insurance Three types of disability income insurance plans are available:
Short-term disability (STD) and long-term disability (LTD) income insurance policies can be purchased individually or obtained through a group such as an employer, association or union. Short-term policies will usually pay a weekly benefit for up to two years. Depending on the specific terms of the policy, a long-term disability income policy may pay you for two years, five years, up to the ages of 65 or 67, or for the rest of your life. Some states have mandated short-term disability insurance programs that were designed to fill the gap from the time a person can no longer work until Social Security disability or LTD benefits start. When you begin to evaluate your insurance needs, start by finding out if your employer, or another association or professional organization to which you belong, offers group disability income insurance. Group coverage is typically much less expensive than individual disability policies. In addition, an employer may pay part or even all of the disability insurance premium. The cost of group coverage is based on the average age of everyone in the group. Typically, young people have less expensive rates and an older group would have more expensive rates. An overview of group disability income insurance policies follows:
Even if you have disability income insurance coverage through a group, you may find that also having an individual disability policy is important. An individual (private) disability income insurance policy is one that you can purchase for yourself. Consider checking into an individual policy if your group policy: 1) does not pay at least 60 percent of your income, 2) does not pay benefits to age 65, or 3) has a waiting period longer than your savings can last. Although an individual disability policy is usually expensive, it is worth the price if you need the coverage. If a disability prevents you from working in your job, this coverage is designed to replace a percentage of your total gross (before tax) income on a tax-free basis. Individual disability income insurance can be very difficult to get and every policy is different. The monthly benefit payment amount, the price of the policy and the length of the benefit period all depend upon the hazards of your occupation, your physical condition and your mental health. An overview of individual disability income insurance policies follows:
Before purchasing individual disability income insurance coverage, carefully review policies offered by several insurers to make an educated decision about which policy best meets your needs. An independent insurance broker can be helpful in terms of finding the best policy for you because they do not represent any one insurer. Individual coverage is likely to be much more expensive than most group policies. Choosing a Disability Income Insurance Policy To choose a disability income insurance policy, start by identifying whether there would be income replacement needs during a period when you are unable to work. Ask yourself how much income would be available from other sources, such as savings, investment income or retirement income if you became disabled and unable to continue working. Consider the following questions about such a situation:
After you have defined your needs, begin your search for the disability income insurance coverage that has the benefits and features you want. Remember to also review your current insurance policies to determine how to keep that coverage should illness and subsequent disability occur. When you are reviewing your disability income insurance coverage, start by checking into policies that may be available to you:
When you are deciding among the many individual disability income insurance policies, consider the following options: 1. The policy that offers the highest payment monthly benefits for which you can qualify if you become disabled. 2. “Own occupation” coverage for life, if this option is available. “Any occupation” coverage can force you to go into a new line of work or lose your benefits. 3. The longest waiting period you can afford. A policy with a short waiting period is usually much more expensive than one with a longer waiting period. 4. Coverage for the longest benefit period possible. If you can find it, a policy that covers to age 65 or even for life is ideal. If you must decide between a higher monthly income and a longer benefit period, the longer benefit period is usually considered to be the best choice. Applying For Disability Income Insurance: A survivor can expect the following when applying for individual or government-sponsored disability income insurance: 1. The application for the insurance policy will ask you questions about your health, including your current health status and health history. Answer each question truthfully, but you do not have to volunteer information that is not requested. Your insurance broker can provide assistance. 2. A medical exam may be required. Generally speaking, the larger the amount of the policy, the more likely you will be asked to undergo a physical. 3. Your doctor will be contacted to supply your medical history. 4. There is no standard timeframe for how long it will take between the time you apply for a policy and when the policy is issued.
5. Disability plans often have a waiting period or the time between the onset of a qualifying disability and when you start receiving benefits. Although some policies have a waiting period as short as 60 days, the wait can be as long as a year. Typically, the longer the waiting period before benefits begin, the lower the premium. 6. Many plans will allow you to choose the benefit period (maximum time your benefits will be paid). For example, a coverage period may pay you for two years, five years, or to age 65. Although it is more expensive, it is usually safer to get a policy that provides benefits to age 65, when you are eligible to receive Social Security benefits or other retirement benefits. If you are self-employed, or plan to buy your own disability income insurance and are eligible for both individual and group benefits, it is best to purchase the individual coverage before you purchase coverage through a group plan. The two main reasons for this are:
Insurance Benefit Denials If your insurance benefit claim is denied, look into it further. Many denials result from errors or the failure to provide sufficient information to the insurance company. When the mistake is corrected, the insurance company may reverse its denial. This is a very important reason why it is necessary to understand your insurance coverage and keep records of your appointments, authorizations and any communications related to your disability. There must be good documentation if you want to be successful in an appeal based on a wrong denial. Be certain you understand the insurer’s appeal process as well as the timeframe required to submit an appeal of a denial decision. If you miss the deadline given for an appeal, you may be required to start over with the application process. If the insurance company makes what you believe is an unfair denial decision more than once, consider asking for assistance from an expert in this area, such as an advocate through a local cancer organization, an attorney or your state’s insurance commissioner. Disability Insurance for Self-employed or Small Business Owners Disability income insurance is important to the financial security of most workers. It is even more important for those who are self-employed or own their own small business because there is a need to cover business expenses as well as personal expenses. Small business owners need back-up systems in place that would allow the business to continue to operate if the owner became disabled. Specifically, if the owner becomes disabled, the income earned from the business would be severely affected and maybe even interrupted. However, both regular living expenses and business expenses would continue for the owner of the business. Disability can be covered by group and individual disability income insurance policies, through various forms of business or professional association coverage, or some combination of both. Options for disability coverage for self-employed or small business owners include: 1. Disability income policies that require no medical underwriting Policies that do not ask any medical questions can provide personal coverage for small business owners and their employees. A minimum of three to five people is generally needed in order to qualify. 2. Group coverage through trade associations, small-business organizations or your local chamber of commerce Insurance coverage may be available through a variety of professional organizations and associations. Find out if you can qualify as a member. 3. Coverage through leasing companies for client employees Leasing companies are available to provide administrative services and employee benefits, including disability income insurance. Business owners may be able to provide coverage for their employees through these programs. There are usually two requirements to qualify for disability benefits:
There are specific benefits that can be purchased as part of the disability insurance coverage for the self-employed or the small business owner. These include:
Premiums paid for business insurance are usually considered a tax-deductible business expense. Benefit payments have to be treated as taxable income when they are received. Government-Sponsored Disability Programs Government-sponsored programs provide disability income benefits through the Social Security Administration (SSA). Keep in mind that there is stricter definition of disability to qualify to receive benefits through these programs than that which is required to receive group and individual disability policy benefits. The Social Security Disability Income (SSDI) and Supplemental Security Income (SSI) disability programs are the largest of the federal programs that provide assistance to people with disabilities. While these two programs are different in many ways, both are administered by the SSA and only individuals who have a disability and meet specific medical criteria qualify for benefits.
When you apply for either program, medical and other information are collected from you and a decision is made about whether or not you meet the SSA definition of disability. The definition of disability under Social Security is different than other programs. Social Security pays only for total disability and no benefits are payable for partial disability or for short-term disability that is expected to last fewer than 12 consecutive months. Disability under Social Security is based on your inability to work. You are considered disabled under Social Security rules only if you cannot do work that you did before and it is determined that you cannot adjust to other work because of your medical condition(s). Your disability must also last or be expected to last for at least one year or to result in death. This is a strict definition of disability. Social Security program rules assume that working families have access to other resources to provide support during periods of short-term disabilities, including workers' compensation, insurance, savings and investments. An overview of the two government-sponsored disability programs follows:
If the research and application process for disability income insurance seems overwhelming to you, ask a professional such as your attorney or a certified financial planner, a cancer advocacy organization, or a knowledgeable family member or friend for help. Although you may never need to use disability income insurance, you are likely to experience some peace of mind knowing that you have made arrangements for a possible future emergency. This document was produced in collaboration with: David S. Landay, Esq., author of Be Prepared, The Complete Financial, Legal and Practical Guide for Living with Cancer, HIV and Other Life-Challenging Conditions. Works Cited: Landay, David S. Be Prepared: The Complete Financial, Legal and Practical Guide to Living with Cancer, HIV and Other Life-Challenging Conditions. New York: St. Martin’s Press, 1998. McCormack, Thomas P. AIDS Benefits Handbook: Everything You Need to Know to Get Social Security, Welfare, Medicaid, Medicare, Food Stamps, Housing, Drugs, and Other Benefits. New Haven: Yale University Press, 2001. Petersen, David. Seminar: Financial Planning for People With HIV/AIDS. New York, 1994. Schneider, Ira S., and Ezra Huber. Financial Planning for Long-Term Care. New York: Insight Books, 1989. Social Security Administration, Social Security Online. Disability Planner, 15 December 2005, and SSA Publication No. 05-10029, Disability Benefits, January 2006. Strauss, Steve. “Disability insurance: You need it.” USA Today, 29 May 2006. Disability Income Insurance: SuggestionsThe suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources. Talk with your family and loved ones about how you could manage financially if you were unable to work. Although talking about a possible loss of income is difficult, you may find sources of income that you had not considered. Your situation may be better than you thought, and if it is not, you can take the time now to make adjustments.
Consider the following questions about disability income coverage:
Take steps to obtain disability income insurance if you do not already have coverage. If you are currently employed: 1) Find out if your employer offers group disability income insurance. Many employers have disability plans that are free to the employee as a part of a group benefit package. Sometimes employees are not even aware that they have group disability coverage. Contact your human resources department to check to see if you are enrolled in such a plan if you do not know for certain. 2) If the answer is “yes,” your employer does offer group disability income insurance coverage, find out if you qualify for the employer’s insurance plan and how your can purchase it. If you are not employed, or if your employer does not provide disability income insurance: 1) Find out if you qualify for individual disability insurance 2) If you do qualify, look into cost and the benefits of purchasing it. 3) If you do not qualify for individual disability insurance, find out if you belong to an organization (or can join one), such as a union, alumni association or other group that offers group disability insurance to its members. 4) If you can obtain group disability insurance through an organization, look into purchasing it if the insurance is affordable and meets your needs. 5) If group or individual disability insurance is not available to you, consider finding out if you qualify for any of the government-sponsored disability programs such as SSI or SSDI. If so, begin the application process for the program for which you qualify. Check into the possibility of working with an independent insurance broker to purchase individual disability income insurance if you are not eligible for coverage, or do not have a group disability income insurance plan available through your employer or other organization. Use the list of questions listed below to compare policies when looking to purchase disability income insurance policies. This will help you decide which policy is better for you. 1. Is the policy coverage for “own occupation” or “any occupation?” 2. What will the policy cover?
3. What laws in your state apply to short-term disability insurance?
4. What are the waiting periods for the policy?
5. What are the specific disability income insurance benefits?
6. What are the policy costs and penalties?
7. What is the insurance company’s rating?
8. What is the process for filing a claim?
Consider other sources of income that may be available if you are not working, such as:
Prepare to provide complete disclosure of all medical and financial information to the insurance company, if you need to purchase your own disability income insurance coverage. The more carefully you document your medical condition and fully describe the severity of your symptoms, the easier it will be for you to make a case for continuing your disability income insurance benefits. Remember to always be truthful in your responses. If it is discovered that an application was completed in an untruthful way, the application will be considered “fraudulent,” and there could be a denial of claims when the coverage is needed. Ask a friend or relative to help you write down information about your medical condition on a regular basis if you are not feeling well enough to do this on your own. Keeping a medical journal of your experiences and symptoms can be a very useful way to document and inform medical and insurance providers about your medical situation. Talk with your doctors about whether they will support your application for disability income benefits if you believe that there is a need to apply for those benefits. Your doctor(s) must provide medical evidence of your disability and inability to work as part of your claim for benefits. Consider asking your doctors:
If your doctor does not support your personal belief that you can no longer perform the required duties of your job, you may need to request another medical opinion. | ||||||||||||||||||||||||||||||||||||||

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