Long-Term Disability Definitions, Part 2

In our last blog we listed long-term disability definitions from A – L. Here are some more definitions to help you understand the terminology used by insurers in your long-term disability policy.

M

Material Duty (or Duties) – Material duties are defined as the set of tasks or abilities required for your particular occupation. These are duties that cannot be omitted or changed without jeopardizing your ability to perform your job. Small differences in material duties can have a significant impact on whether you qualify for disability benefits.

Maximum Capacity – The full utilization of the employee’s abilities in any occupation that he or she is capable of performing.

Maximum Monthly Benefit – The highest payment under the Long-Term Disability plan, a disabled employee can receive monthly.

Mental Health Limitation – Benefits for mental health conditions such as depression, anxiety or bipolar disorder will only be paid for 24 months.

N

Non-contributory Plan – a group coverage plan in which the employee does not contribute, and the employer pays the entire premium.

Non-Exertional Limitations – Non-exertional limitations include fatigue, intellectual and cognitive limitations, headache, memory loss and medication side effects.

O

Offset – Payments or benefits received by the claimant from a third party that reduce the amount of long-term disability benefit payable, including settlements from lawsuits, Social Security disability, certain retirement disability benefits, Workers’ Compensation, and certain state disability benefits.

Own occupation – A claimant needs to be unable to perform their “own occupation” that they have been trained to perform for the first 24 months or as defined in the policy.

P

Plaintiff – a person who opens a lawsuit in a court of law.

Policy / Contract – A legal agreement between a person or a group and an insurance company listing all the details of the plan’s coverage.

Policyholder / Contract Holder – A person or group who purchases an insurance plan from an insurer.

Pre-existing Condition – a medical condition for which a person has received medical care prior to the effective date of the policy.

Punitive Damages – A money award that the injured plaintiff receives when the insurance company has been found to engage in fraudulent, oppressive or malicious behavior.

R

Rate of Benefit – The percentage of income to be replaced by the disability plan.

Residual Disability – If you are physically unable to perform some, but not all, of your regular job functions because of sickness or injury.

Residual Functional Capacity (RFC) – A claimant’s RFC is based on the level of work a person can physically perform. The levels are sedentary, light, medium, heavy and very heavy.

S

Salary Percentage Requirement – The insurance company is required to find occupations that pay at least 80% of the claimant’s pre-disability income.

Schedule of Benefits and Exclusions – The section of the disability insurance policy that describes what the policy covers and what it does not cover.

Self-reported Symptoms Limitation – Some policies have a provision that limits coverage (often for two years) for disability benefits based on self-reported symptoms such as Chronic Pain, Chronic Fatigue Syndrome and Fibromyalgia.

Statute of Limitations – A legal provision which sets a time limit for initiating legal proceedings.

U

Underwriter – The responsible company that receives the insurance premiums and carries out the policy contract.

V

Vocational Expert Opinions –A vocational expert forms an expert opinion on what jobs a claimant may be able to perform taking into account all restrictions and limitations caused by the impairment, as well as age, education, background, work experience and skills.

W

Waiver of Premium – Individuals who become disabled and qualify for benefits are not required to pay any additional disability premiums during the period that benefits are being paid out.

Need Help with Long-Term Disability?

Talk to us at Cunnane Law today about your claim. We are ready to assist you if you have been denied long-term disability benefits. It is critical that you understand the terms of your policy as well as the law.

Note: This information was provided not for any specific claim and is written in broad and general terms and may not be the right path to follow for a particular claim or case. This information is not intended to create an attorney client relationship. It is always best to receive direct legal counsel for your legal issues. It is never too early to call the attorney, but it can be too late.