By Scott Nelson-Archer, CLU, ChFC
Last week we had a general surgeon call us about their skiing accident or semi skiing accident he had. The reality was he was getting off the gondola, walking to the slopes when he slipped on a piece of ice causing him to fall and catch his thumb on the edge of his ski. When he caught his thumb on the edge of the ski it caused a cut at the base of his thumb…his dominate thumb. To get to the point without more details he is having some real issues with nerve damage and is now unable to do surgery for the foreseeable future. So the question is “how will my disability policy work”?
Depending upon your contract language, it will determine if it pays at all, some, or everything he bought. Now he happened to have several policies, one through me, one through a national medical association, and a group policy for which he had been told or he thought he had an own occupation definition on all 3 of them, well that is not exactly how it turns out. With the Association plan, he actually does not qualify for coverage since he had a clause in the waiting period that states he has to be Totally and Continuously out for 90 days before benefits start. Because he can still consult with patients even though he can’t perform the surgery, he is not Totally disabled thus not eligible for claim. On the group policy, he has a 180 day waiting period so he won’t get claim dollars rolling in until May. That is a long time but he will be eligible since he does not have the words Total or Continuous in his policy. However, even though he does have an Own Occupation clause in that policy it limits him to both Not Working in another occupation and after 24 months of claim he then has to be unable to do ANY job for which he is reasonably trained, educated OR experienced. Finally on the policy design we put in place he does not have a Total or Continuous clause in his policy, he does not have a time limit on his true own occupation / own specialty definition, and he does not have any benefit reduction for working in any other occupation. My point here is words matter, design matters, and full understanding of the policies matter.
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