Disability Insurance Terms

Disability Insurance Terms

Disability Insurance policies commonly include language and terms not used in every day life. This glossary provides the most common terms related to Disability Insurance and helps you understand what they mean.


A

Accident
An unforeseen and unplanned event.

Accidental Death Benefit
Benefit payable if death occurs due to an accident.

Accidental Death and Dismemberment Benefit
Benefit payable if death or dismemberment occurs due to an accident.

Accumulation Period
The number of consecutive months, starting on the first day of disability, during which the elimination period must be satisfied.

Active, Full-time Employee
An individual that works for the employer on a regular basis (generally based on a minimum number of regular work hours) in the standard course of the employer’s business.

Association Coverage
Group Disability Insurance issued to members of an association.

Automatic Increase Rider
An optional benefit which provides automatic increases each year for a limited number of years, despite changes in health, occupation or income.

 

B

Benefit Percentage
The percentage of the insured’s pre-disability income upon which the payabel benefit is based, up to an overall maximum benefit.

Benefit Period
The longest period of time for which benefits are payable for continuous disability.

Business Overhead Expenses
The usual expenses required to maintain an office or run a business.

Buy-Sell Agreement
An agreement made by the owners of a business to purchase the share of a disabled or deceased owner. The value of each owner’s share of the business and the exact terms of the buying and selling process are established before death or the onset of a disability.

 

C

Capital Sum Benefit
The benefit provided when the insured suffers the loss of a hand or foot, severed through or above the wrist or ankle, or loss of the entire sight in one eye with no chance of recovery.  The loss generally must be the result of sickness or injury that the insured has survived for at least 30 days.

Conditional Receipt
A receipt for premium payment accompanying an application for insurance.  If the application is approved as applied for, the coverage is effective on the later of the date of prepayment or the date on which the last underwriting requirement was received by the insurance company.

Consumer Price Index
A measure of inflation that quantifies the rate of change in the cost of living in the United States.

Conversion Privilege
The right given to an insured person to change insurance without evidence of medical insurability, usually to an individual policy, upon termination of coverage under a group contract.

Cost of Living Rider
An optional benefit that provides for increases in disability benefit during periods of disability.

Cumulative Benefit
An insured’s monthly benefit times the number of months the of disability after the elimination period.

Current Expenses
An insured’s monthly expenses during a residual disability.

Current Income
All income received by the insured during a residual disability.

 

D

Definition of Partial/Residual Disability
The actual terms and detailed description of “disability” sometimes used to describe when an insured is able to return to work part-time or even full-time (with a loss of earnings).  If working in this limited capacity and is earning less than a certain level of income, the insured may still be eligible for limited benefits.

Definition of Total Disability
The actual terms and detailed description of “disability” that will be used to determine an employee’s eligibility for benefits.  Examples include but are not limited to:

Own Occupation (Own Occ) Under this definition, an insured will be considered disabled only if he/she is unable to perform the duties of his/her occupation

Any Occupation (Any Occ) Under this definition, an insured will be considered disabled only if he/she is unable to work in any occupation for which he/she is qualified by education, training, or experience. This is somewhat similar to the definition that the Social Security Administration uses in determining disability.

Disability
The physical or mental inability of individual’s to perform major occupational duties because of illness or injury.

Disability Insurance
A type of insurance used to replace some portion of income in the event the insured cannot work due to illness or injury.

 

E

Earned Income
Walary, wages, commissions, etc., received as payment for active employment.  This does not include unearned income from investments, annuities, rent, etc.

Elimination Period
The number of consecutive days for which no benefits are paid following a claim and during which the insured must be disabled.

Evidence of Insurability
Medical and/or financial proof sometimes required of an applicant employee to demonstrate to the insurance company that he/she is insurable.

Exclusions
Specific situations under which benefits will not be paid by a policy.

 

F

Family Care Expenses
An optional benefit that provides credit or partial reimbursement for certain expenses incurred for family care.

Foreign Residency Limitation
A common limitation of benefits for when the insured is not a resident of the United States or Canada.

Fractional Month
The payment of benefits at the rate of 1/30th of the monthly amount for each day the insured is disabled for less than a full month after the elimination period has been satisfied.

Future Increase Option
An optional benefit that allows the insured to purchase additional coverage at any age, regardless of health, subject to financial ability to afford the additional coverage.

 

G

Grace Period
A stated amount of time, in which a policyholder may pay a premium after the due date while keeping the full policy in-force.

Group Insurance
A policy offered to employees of a company or members of a union.

Guaranteed Renewable
An insurance policy provision that prevents the insurance company form cancelling or making changes to a policy for a stated period of time during which the policy is in-force.  Policy premiums may increase, however.

 

I

Incontestability
A disability claim, as defined the the policy, cannot be denied once the policy has been in-force for at least 2 years with the exception of fraudulent statements in the applications.

Indexing
A provision that increases pre-disability earnings annually according to a stated formula to help keep residual disability benefits from losing purchasing power due to inflation

Injury
Accidental bodily injury occurring while a policy is in force

 

K

Key Employee
An owner or highly skilled employee whose contributions to the business are critical to the continuing success of the company.

 

L

Level Premium
A premium that remains unchanged until the insured reaches a stated age.

Lifetime Disability Benefit
A lifetime benefit payable if the insured is continuously and totally disabled after a stated age.

Limitations
Specific provisions included in disability policy that limit coverage in certain situations.

Loss of Income
The difference between an insured’s income before and after disability.  If the loss is greater than 75%, it is considered to be 100% and the full disability benefit becomes payable.

Loss Payee
The individual or entity named to receive all benefits per the policy.

Lump Sum
A single and complete payment of all benefits due.

 

M

Mandatory Rehabilitation
A provision that encourages disabled employees to participate in rehabilitation efforts whenever appropriate.  Such a provision allows for termination of benefits if the employee refuses to cooperate or participate with a rehabilitation plan.

Maximum Monthly Benefit
The highest dollar amount the insured can receive on a monthly basis under a disability plan.

Maximum Benefit Period (Benefit Duration)
The maximum length of time for which benefits are payable under a policy plan as long as the insured remains continuously disabled.

Medical Care Requirement
An insurance company’s right to deny benefits for any period in which the insured is not under a physician’s care.  Companies may require that care be appropriate, according to generally accepted medical standards, and be provided by a physician whose specialty is appropriate for the condition.  The requirement may be waived if reasonable proof is presented that a physician’s care is no longer necessary.

Minimum Monthly Benefit
The minimum amount paid as a monthly benefit after reductions for other income.

Monthly Indemnity
The amount an insurer will pay for each month of total disability after the elimination period.

 

N

Noncancellable Policy
A policy that cannot be cancelled or changed by the insurance company as long as premiums are paid on time. In addition, premiums on such a policy cannot increase until the insured reaches age 65.

 

O

Optional Benefit
An additional policy benefit offered by the insurance company which may be included at the applicant’s request for an additional cost.

Overinsured
Receiving disability benefits in excess of income earned while working.

Own Occupation (Own Occ)
A definition of disability stating that the insured will be considered eligible to receive the policy’s full benefit as long as the he/she is unable to perform the standard tasks of his or her regular occupation(s) at the time of disability.

 

P

Partial Disability
The physical or mental inability of an insured to perform at least some, but not all, standard duties of his or her regular occupation(s).

Participation Limit
The total amount of coverage an insurer will allow on an individual after considering total amount of current insurance in-force or for which the insured is considered eligible.

Pre-Existing Condition
A physical or mental condition which existed prior to the issuance of an insurance policy.

Presumptive Disability
The presumption that the insured is totally disabled, even if still at work, if illness or injury results in the total loss of sight in both eyes, hearing in both ears, speech, or use of any two limbs.  The elimination period is waived from the date of loss and total disability benefits are payable during the loss until the end of the benefits period.  Ongoing care of a physician may or may not be required.

Prior Expenses
The calculation of average monthly expenses for the same period during which prior income is based for the purpose of residual disability coverage.

Prior Income
The insured’s earnings prior to disability.  This may be calculated as average monthly earnings for the last full calendar tax year or as the average of the highest two of three preceding years, or using another measure.

 

Q

Qualified Sick Pay Plan
Also called a Salary Continuation Plan, this is a plan offered by a business to continue the salary of specified employees should they become disabled.

 

R

Recovery Benefit
A policy option that provides some benefits when the insured returns to work following a period of disability.

Recurrent Periods of Disability
Depending on the policy, separate periods of disability may be considered one continuous period if each period is due to the same cause(s) and is not separated by a minimal recovery time (usually 6 months).

Rehabilitation Benefit
A benefit to help reimburse the insured for costs incurred while participating in rehabilitation programs for the purpose of returning to his or her occupation(s).

Reinstatement
The conditions around which a policy may be kept after it has been allowed to lapse.

Residual Disability
Disability insurance that covers a partial disability as defined in the policy.

 

S

Salary Continuation Plan
Also called a Qualified Sick Pay Plan, this is a plan offered by a business to continue the salary of specified employees should they become disabled.

Social Insurance Offset / Substitute Rider
An option that pays a benefit if the insured is disabled and not receiving social insurance benefits.

Social Security Disability Insurance (SSDI)
A federal cash benefit that may be available if a person is disabled under the definitions of Social Security and eligible for benefits.

State Disability Benefit Insurance Laws
Laws enacted in California, Hawaii, New Jersey, New York, Rhode Island, and Puerto Rico that require employers to provide disability benefits for the non-occupational disabilities.

 

T

Term Changes
The option to change a policy premium from or to annual, semi-annual, quarterly, or monthly.

Total Disability
The insured’s physical or mental inability to perform the duties of his or her occupation(s) due to illness or injury.

 

U

Unemployment Premium Waiver Option
An option that can waive premiums for a limited period of time in the event the insured becomes unemployed, regardless of disability.

 

W

Waiver of Elimination Period
Depending on the policy, the elimination period may be waived if an insured becomes disabled within five years after the end of a period of disability of longer than six months and for which benefits were paid.

Waiver of Premium
A benefit that alleviates the insured from making premium payments after being disabled during the lesser of the elimination period or 90 days.  The policy may also refund premiums paid during the first 90 days and eliminate premiums due during the 90 days after recovery.

Worker’s Compensation
Benefits mandated by law to compensate employees for losses incurred due to a work-related illness or injury.