Understanding Your Disability Policy

New York Disability Insurance Attorney Explains Disability Policies

Some people have a private disability insurance policy that they shopped for and purchased on their own.  They pay premiums directly to the insurance company to keep the contract in force.  The contract can’t be changed by the insurer, and you hold onto it for as long as you pay premiums.  If you don’t have that type of disability coverage, then you might have short term and long term disability coverage under a policy offered by your employer.  In that case, your employer pays the premiums to the insurance company, and the employer or the disability insurance company supplies you with a certificate of coverage that outlines the provisions of your disability coverage.  You either contribute to payment of the premiums through deductions from your paycheck or the employer pays for the coverage as a benefit of employment.  Under both types, there is language that all disability policies have in common.  If you don’t have a copy of the policy, contact either the company that sold it to you or your employer’s human resources department if it is a group employer policy, and ask for a duplicate version for your records.

State and Federal Law Governing Your Disability Insurance Policy

Most people are surprised to learn that the language in their policies is actually governed by state or federal law.  For those who own private policies, state insurance statutes and regulations determine certain wording that must be in the policies.  State law also assists in determining your rights under the policy if there is ever a dispute.  For employees who have coverage through their employer, usually the federal statute ERISA – the Employee Retirement Income Security Act of 1974 – dictates your rights and obligations under the policy or Plan.  Every state has different rules, and depending upon where you live and where the long term disability plan was effectuated, different ERISA rules may apply to your claim.

Declaration Pages of Your Disability Contract

All policies have a page or two that gives you information concerning the amount of your monthly benefit, the length of time you must wait in order to receive benefits and the length of time the policy will pay benefits.  These pages are often referred to as declaration pages.  The pages declare the specifics of the policy as they pertain to you.

Total Disability Definitions in Your Long Term Disability Contract

All policies contain definitions to allow the insured or reader of the policy to understand how the policy will be administered if you have to make a claim.  One very important section contains definitions of total disability or partial disability, sometimes referred to as residual disability.  Some policies define total disability as due to sickness or injury, you are unable to perform the material and substantial duties of your occupation.

Notice of Claim and Proof of Loss Provisions in Your Disability Income Insurance Contract

Another section in disability contracts commonly reviewed is the section that identifies when you have to notify the company of a claim and when you need to provide proof of your disability.  These are called Notice of Claim and Proof of Loss or Proof of Claim provisions.  Notice of Claim provisions in disability policies generally ask you to notify the insurer of your claim within 20 or 30 days of the date you become disabled. Proof of Loss provisions give you deadlines for providing proof and sometimes define the type of proof that an insurance company can ask you to provide.

Contact Gisonni Law Firm

There are numerous other areas of a disability income insurance policy that contain language that you should be aware of to protect your rights.  They include clauses that allow the insurance company to have a physician perform a medical examination on you, offset provisions that tell you when a disability insurer can reduce your monthly benefit if you are receiving Social Security Disability benefits, and if you have a partial disability claim, the manner in which the insurance company calculates your benefits if you are earning an income while disabled. Gisonni Law Firm has been assisting insureds understand their policies for two decades.  When an issue arises in your claim, call a law firm that you can depend on to fight for your rights. If you need our help, contact Gisonni Law Firm, P.C. for a consultation.