By Peter Casciano, Esq.
Long term disability insurance plans will pay you a monthly benefit if you can prove that you meet the “definition of disability” provided in the respective plan. Each “definition of disability” is different and crafted specifically for your plan. However, the most common definitions require claimants to prove they are disabled from their pre-disability occupation or any full time occupation.
How Do You Define Catastrophic Disability?
Beyond the common “definitions of disability,” plans can tweak each definition by requiring the claimant to prove they are medically unable to earn a certain income level such as, for example, “60% of the claimant’s previous salary.” The bottom line is that each plan is different, with different clauses and definitions impacting the “definition of disability” used to decide the claim.
A somewhat rare clause or rider is known as a “catastrophic disability benefit.” It is by no means included in every long term disability policy; it is slightly more likely to be included in an individual disability policy rather than a group policy. If your policy does have this clause, it could significantly increase the value of the disability awarded.
How Catastrophic Disability Benefits Work
A “catastrophic disability” will pay a claimant an increased monthly benefit, on top of the standard disability benefit, if the claimant can meet the more difficult catastrophic definition of disability. An example of a “definition of catastrophic disability” is that the claimant must prove that due to injury or sickness, they are unable to perform two activities of daily living without the assistance of another person. Activities of daily living include eating, continence, transferring, toileting, dressing, and bathing.
Another example of a “definition of catastrophic disability” is that the claimant must prove they have suffered a deterioration in intellectual capacity which requires another person’s assistance to protect the claimant or others, as measured by clinical testing. It is important to understand that a catastrophic disability benefit may arise after the claimant meets the standard definition of disability provided in the policy. For instance, one may become disabled from their previous occupation and receive long term disability benefits at the standard amount for five years. That same claimant could then experience a sudden medical crisis which causes the claimant to now meet the heightened definition of catastrophic disability. The claimant could then begin receiving the increased monthly catastrophic disability benefit as a result of this medical crisis.
Disability Benefits Lawyers in Maryland
As you can see, one must be familiar with the ins and outs of the applicable disability policy even after disability benefits begin. The insurance company will likely not educate claimants on the intricacies of the plan. It is up to the claimants to seek advice and representation to ensure that they fully capitalize on the benefits available to the claimant. The definition of disability applicable to each claimant can change and shift as the facts of the case change. Only an experienced disability benefits attorney can help claimants navigate this complex landscape. It is critical to understand the different classifications of benefits and then perfect a claim depending on the facts.
For a free disability benefits consultation in Maryland, including a review of your particular disability policy, please contact Peter Casciano.
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