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Whether you are shopping for a private disability insurance policy or need to file a claim, it is important to understand how long the disability insurance benefits can be expected to last. The answer depends on a variety of factors.

Often, the fine print in your disability insurance policy will provide the information you need to assess the duration of benefits, but sometimes the factors that affect the duration of benefits are not well-defined within the policy itself. If you believe an insurance company has wrongfully discontinued benefits, an attorney who focuses on private disability insurance can help you recover your rightful benefits.

Consider the Type of Policy

The policy category is one of the most critical factors that impact the length of disability benefits. In particular, you need to determine whether you’re looking at a short-term or long-term disability policy.

As the names suggest, short-term policies won’t pay benefits for very long. Terms can vary considerably, but usually, benefits last for no more than 3-6 months. In rare instances, a short-term disability policy might pay benefits for up to a year, but the period could be as short as 30-60 days. By contrast, a long-term disability insurance policy will not usually pay benefits right away, but the benefits will be paid out for a much longer period.

Another category to consider is whether the policy is an individual disability insurance policy or a group disability insurance policy. Group policies are often offered by employers as part of a benefits package, so rules about eligibility and continuance of benefits may be specifically tailored to the goals of the employer. Terms in group policies often change year-to-year as employers renegotiate the deals they’ve struck with insurance providers. When you purchase a private individual policy, the terms are established in your policy and your contract is directly with the insurance company instead of between the employer and insurance company. The company will not be able to change terms unless you’ve agreed to accept changes as part of the contract.

Consider the Terms Set Forth in Your Policy

Some types of insurance, such as car insurance, are heavily regulated with regard to the terms they must offer to consumers, but that is not the case with private disability insurance. Insurers are generally free to offer whatever terms they want, although bad faith and deceptive practices laws require them to honor the terms and maintain a certain level of clarity in the offerings.

This means that it is essential to look at the details of the terms offered in a policy to understand how long benefits could potentially last and the factors that could cause benefits to be discontinued. Some policies, for instance, might initially pay benefits if you are unable to work at the specific job you were performing when you became disabled, but after a certain period of time, the standard changes. The policy might specify that after 12 or 24 months of benefits, you must prove that you are unable to perform “any occupation” in order to continue receiving benefits.

A disability insurance attorney could review the fine print of your policy to assess the factors that determine how long benefits should be paid in different situations.

Consider Your Condition

Changes in your condition will impact the duration of disability insurance benefits if the changes meet certain criteria. You might recover to the point where the insurer determines that you are no longer suffering from a disabling condition that qualifies you for benefits. Or, the insurance company may erroneously believe that your condition has improved to a level that disqualifies you from receiving benefits, in which case, you may need to take legal action to disprove their assumption and get your benefits reinstated.

When reviewing changes in your condition, it is important to consider both the disability itself and your ability to perform job functions with that disability. For instance, your insurer might decide that minor improvements in your condition make it possible for you to work if you rely on technological tools or assistance that weren’t available when you first applied for benefits. The insurer’s assessment may not be at all realistic or in compliance with the terms of your policy, so it is a good idea to consult a disability insurance attorney if benefits have been discontinued for no reason or if you believe the reason is invalid.

Look at the Benefit Period in Your Policy

Of all the terms in your disability insurance policy that are likely to affect the length of time insurance benefits will last, the benefit period is the term with the most direct correlation. Specifically, your policy should describe how long benefits will be paid in particular situations. As noted above, for short-term disability insurance, the maximum benefit period may only be two or three months. For a long-term policy, benefits might continue:

• For a set term such as 24 or 36 months
• Until you reach retirement age
• Until your recovery reaches a certain level
• Until you are able to perform certain job functions

As you might expect, a policy with lower premiums might have a much shorter benefit period than one with higher premiums.

It is important to determine whether the terms that limit benefits are defined in the policy. For instance, if the policy says that benefits could continue until you reach “retirement age,” is that phrase explained? Even the Social Security Administration has different definitions of “retirement age” depending on the birth date of an applicant. 

In addition, consider how the terms are applied. If benefits can be paid for a maximum of 60 months, for instance, is that 60 months from the onset of the disability, 60 months from the time you apply for benefits, or 60 months from the time you begin receiving benefits? Also, take note of whether you can reapply if your disability changes or grows worse. For instance, back pain from an accident could be classified as muscular, but you could later be diagnosed with damage to your spine from the same accident, and you might be entitled to an additional term of benefits based on the later diagnosis or deterioration in your condition.

Benefits Could Be Decreased

Depending on the terms of your policy and your situation, your disability insurance carrier might determine that you are only eligible for partial benefits. This might happen if you are able to return to performing your previous job but for fewer hours than before. It might also happen if you can work in a position that does not provide the same income. As with everything, it is important to look at the terms in the policy and see whether the insurance company is acting in good faith in interpreting the policy terms.

Talk to a Disability Insurance Attorney if You Believe Benefits Have Been Wrongfully Terminated or Reduced

Insurance companies are in business to make money, and for that reason, they will often look for any reason to stop paying benefits. Sometimes, their actions are appropriate, and other times, they are not, but if you don’t examine the legality of their actions carefully, they could be wrongfully denying benefits that you’ve paid for through your insurance premiums.

The team at Seltzer & Associates focuses on helping professionals such as physicians, executives, and accountants receive the full disability benefits they’re entitled to when a disability prevents them from working in their chosen profession. If you have questions about your policy or need assistance filing a claim, appealing a denial, and investigating a termination of benefits, we invite you to contact our team for a complimentary consultation to learn how we may be able to assist. Just call 888-699-4222 or contact us online to get started.