Long-Term Disability Definitions, Part 1

If you have a disability claim, you’re already at a disadvantage attempting to decipher 90% of the material you’re now required to read, comprehend, and answer to. A glossary is required to make sense of the provisions of your long-term disability policy. This list of definitions of disability insurance terms will assist you.

A

Active Full-Time Employee – A full-time employee who works a regular workweek for a company is known as an active full-time employee.

Active Work Requirement – To be eligible for disability benefits, you must be working at least the minimum number of hours per week as described in your company’s policy.

Activities of Daily Living (ADLs) – Routine activities that people do on a daily basis without assistance. Eating, bathing, dressing, toileting, walking, and continence are the six basic ADLs.

Adjuster – An insurance company employee or subcontractor who investigates insurance claims and determines how much the insurer must pay for a submitted claim.

Attending Physician Statement – A medical report written by the insured’s doctor that details his or her medical history, both past and present.

B

Bad Faith – Insurance companies are legally bound by a “covenant of good faith and fair dealing.” When an insurer breaks this covenant by delaying or denying payments in an unreasonable manner, it is considered to be acting in bad faith.

Beneficiary – The person or entity authorized to receive the proceeds or benefits of an insurance policy.

C

Catastrophic Disability – A claimant is so severely disabled by an accident or disease that he or she need assistance with even the most basic tasks of daily living, such as feeding, dressing, or showering.

Claim – A payment request made under a disability insurance policy.

Contributory Plan – A group insurance plan in which a company and its employees split the costs.

D

Deductible – A stipulation in a disability insurance policy requiring the policyholder to pay an initial amount of expenses before the disability insurance coverage begins.

Disability – The criteria used by the insurance company to evaluate if you are disabled and entitled to benefits.

Disability Appeal – If your claim is denied, you have the right to appeal and legally challenge the denial in a court of law.

E

Effective Date – The day the insurance policy starts.

ERISA – ERISA (Employee Retirement Income Security Act of 1974) is a federal law that regulates the handling of Employee Benefit Plans.

Exclusions – Specific conditions under which a disability will not be covered are outlined in disability policies.

F

Functional Capacity Exam (FCE) – A series of physical tests to see if a claimant can return to work.

G

Group Coverage – Individuals can get group long-term disability coverage through their company, a professional group, or an association.

I

Individual Disability Insurance (IDI) – Disability insurance for individuals can be acquired directly from an insurance broker. The individual is responsible for all costs.

Insured – A person or organization covered by insurance.

L

Long Term Disability Insurance – Long-term disability (LTD) insurance provides monthly benefits (income replacement) if a person is unable to work for more than two years due to illness or injury.

Lump-Sum Payment – Disability benefits are usually paid in a lump-sum on the day after the Elimination Period expires.

Your Long-Term Disability Experts

At Cunnane Law, we are highly experienced in assisting people with their long-term disability claims. Our lawyers work tirelessly to represent you and your interests in your dealings with insurance companies. You need all the facts, all the information, and all the help you can get. We’ll be publishing Part 2 of this guide soon, but in the meantime, if you have questions, contact us. We work with clients in Edmonds, Shoreline, and all across the greater Seattle and western Washington area.

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.