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 Definitions Of Disability

 


Defined By Occupational Classes

What policy language do insurance companies use to determine benefit entitlements?

 Special Wording For Professionals
If a professional is in a recognized specialty, and has limited his/her practice to that  specialty, the specialty will be considered his/her occupation for the purposes of defining contractual benefits.


  Own-Occ, Own Occupation
The insurance industry  intends this definition to mean that you have the inability to work at your "regular occupation", that is, the inability to perform the material and substantial duties of your own occupation. 

The Own-Occ definition is a more favorable definition to the insured

  Modified Own-Occ
In a modified own-occ policy contract, the insured is unable to perform the material and substantial duties of the intended occupation and
"not working in any occupation". Unlike the own-own definition, the "modified own-occ" definition will financially penalize the insured if he/she earns money from another job. The insurance company will reduce your benefits based on your new earnings.

  Any-Occ, Any Occupation
The inability to work at "any occupation"
which is the inability to perform the duties of any occupation by which the individual is suited by training, education or experience.

  Dual Definitions
Individual policies can offer a “dual definition” of disability. Policy may use an own-occupation definition for the short-term, at which time the definition will change to any-occupation definition.  The longer the own-occupation definition is covered under the policy, the higher the required premiums.

Occupational Classification Guidelines

Applicants must be employed on a full-time basis (at least 30 hours per week) at time of application.  Applicants employed only in seasonal occupations are not eligible for coverage.  Applicants engaged in more than one occupation, even on a part-time or seasonal basis, will be classified according to the most hazardous occupation.

  Business In The Home
Generally, persons who work at a business in their home are not eligible for disability income coverage, unless at least 50% of the job duties are performed away from the home.

  New Occupation Or New Business
Individuals just entering a profession, business, occupation, or becoming associated with a new business generally must have a minimum of 12 to 24 months in their new field in order to obtain the maximum amount of individual disability income insurance available. However, this requirement may be waived if the applicant has been in a similar occupation for at last two years. Individuals who do not fall into one of the above categories may be given individual consideration. Underwriting should be consulted prior to submitting an application.

  Aviation / Avocations
Persons involved in aviation, auto racing, hang gliding, sky diving, skin/scuba diving, or similar activities on an amateur basis may be considered for individual disability income insurance in most cases. Report the activity on the application and complete the appropriate Avocation Questionnaire. Usually, a Policy Amendment Rider (waiver) will be attached to the policy if the application is approved.

  Foreign Nationals
Applications may be taken on U.S. citizens who permanently reside in the U.S. or are permanent resident aliens who have lived in the U.S. for at least three years and do not plan to return to their native country on a permanent basis. A photocopy of both sides of the applicant’s resident alien card must be submitted with an application.

 
To Age 65 Benefit Periods
Proposed Insureds in Occupational Classes 4A and $3A are generally eligible to apply for To Age 65 benefit periods without regard to income. Proposed Insureds in 2A

Occupational Classes may apply for To Age 65 benefit periods if the following conditions are met: Self-Employed Applicants: Must be under age 56, have worked in and owned the business for the last 2 years, and have annual net income of at least $40,000 for each of the last 2 years. W-2 Wage Earner Applicants: Must be under age 56 with annual gross income of at least $40,000 for each of the last 2 years. To age 65 Benefit Periods are not available to any 1A Occupational Classes.
   

Related Topics
                  Types of Disability insurance coverage
   
                  Renewability  Provisions  
               
  Benefits       
                
  Definition of Total Disability   
                
  Optional Benefits
                  Residual Disability Benefits   
                  Other Policy Benefits   
                  Terms
                ●  Occupation Definitions   
                
  Occupation Class Look Up  
                                            
Not all insurance products from all insurance companies are available in all states.
Note:  We do not provide legal or tax advice. The general information presented on various tax aspects contained in this site are not intended to be relied upon as tax advice. Individuals should seek the advice of a qualified tax professional regarding the taxation of these benefits as they apply to your particular situation.  These benefits are offered in all states except: AK, HI, & WY. License #'s: CA: OC38446 MT: 29724 F00-0283-LC 


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