What is Disability Insurance ?
Disability insurance provides income replacement after an injury or illness makes working impossible for a brief time or forever. The best-known forms of disability insurance are workers’ compensation and Social Security. Individuals can also carry private disability coverage through their job, or they can purchase a disability policy in the same way that they get automobile insurance and homeowner’s or renter’s insurance.
Agee Clymer Mitchell and Portman’s Cleveland disability lawyers have addressed Ohio workers’ comp and Social Security Disability Insurance (SSDI) in earlier posts to the firm’s website. Here, we look at privately purchased personal disability coverage plans.
Do You Need Your Own Disability Insurance?
Only you can make that determination. Here are four of the factors you need to consider:
- No one needs any kind of insurance until they do. This, admittedly, is not strictly true. You can get ticketed for not having car insurance, for instance, and denied a loan for not having a policy for a house you want to buy. The points holds, however, that paying premiums on most forms of accident and health coverage can seem like useless expenses until the worst happens. Weighing costs against risks is necessary.
- Workers’ comp and Social Security do not cover everyone. If you work for the government at any level, for a public school or university, or for yourself, you probably will not qualify for workers’ compensation of SSDI benefits for the simple reason that neither you nor your employer pay into the programs. Payroll taxes and paycheck deductions that rarely affect public employees and independent contractors fund federal and state disability programs.
- Workers’ comp and SSDI claims often get denied. In 2010, just more than one-third of all SSDI applications got approved. During the state’s 2014 fiscal year, the Ohio Bureau of Workers’ Compensation provided benefits to 97,572 new claimants while still having 858,773 cases under review. Safety nets sometime have large holes.
- Some jobs come with significant risks for illness and injury. Commercial drivers, construction and maintenance workers, and factory and warehouse workers face more dangers on the job than do people who sit in offices. With workers’ comp and SSDI not guaranteed, carrying private disability insurance can make sense for those in high-risk professions.
What Does Disability Insurance Cover?
As noted, disability insurance replaces income. Short-term policies start paying immediately, with benefits set as a percentage of the policyholder’s earnings before he or she got hurt or sick. Long-term policies begin paying benefits several months or a year after a disability becomes apparent.
In general, a qualifying disability can fall into any of the following categories:
- Temporary, typically considered to be an injury or illness that keeps the person out of work for more than a week but less than six months
- Long-term, an injury or illness that keeps the person out of work for a year or longer
- Partial, a condition from which a person recovers enough to start working again but which limits earnings and physical function
- Permanent, a condition that partially or totally limits earnings and physical function for the person’s entire life
- Total, an injury or illness that leaves a person completely unable to work
The exact provisions of disability insurance policies vary from contract to contract and from insurer to insurer. The terms and benefits also depend on how much a policyholder pays in premiums. Benefits can be paid monthly or in lump sums and used for any expense the beneficiary chooses, from settling medical bills to making mortgage payments.
How Does the Disability Insurance Claim Process Work?
A policyholder does not have to get injured or sick due to work-related activities to qualify for private disability insurance payments, but the person does have to present convincing medical evidence of a disabling condition. Doing that often requires getting examined and assessed by doctors and occupational specialists chosen by the insurance company. Periodic reassessments of a beneficiary’s ability to work are also likely.
It is important to note that the condition usually only has to keep a person off the job. Broad exclusions from workers’ comp and SSDI eligibility for common problems like back pain and respiratory diseases generally do not apply under private disability insurance policies.
Do You Need Assistance With a Disability Insurance Claim?
Dealing with an insurance company for any reason can leave you confused, frustrated, and uncompensated for a legitimate claim. Any of those outcomes are understandably unacceptable if you find yourself struggling physically, unable to work, and counting on disability benefits you have paid toward.
The experienced disability lawyers in the Cleveland offices of Agee Clymer Mitchell and Portman may be able to serve as your legal champion. We welcome opportunities to help individuals prepare disability claims and appeal denials. Contact us online or call (800) 678-3318 to request a free case consultation.