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Life's a Risky Business: Definitions of 'Disability'

By Elaine Sambugaro |

Definitions of "Disability"

James Piper, an independent chartered accountant, cautions that the definition of disability ought to be studied carefully to prevent the insurance agency from denying legitimate claims.

"Insurance companies will say you can work and deny the claim," Piper said.

"How? They play games with the meaning of work. You want disability that relates to the type of work you currently do. This will avoid them [the insurance company] from saying that you can work flipping burgers or working at a credit collection agency," he said.

David Lackman, a lawyer with ON-based Lackman, Firestone Law Offices, specializes in litigating the denial of disability insurance claims.

He agrees that fluctuating definitions of disability can become loop holes in a policy and one of the main reasons claims are denied by insurance companies. In many cases, Lackman explains that the shift is from the "own occupation" to the "any occupation" definition.

"These definitional changes are in the policy when you buy them," Lackman said. "If you read the actual terms and conditions in many policies, you'll see that for the first 104 weeks you have to be unable to do your own occupation. After the 104 weeks, you have to be unable to do your own and any occupation," he said.

There are three common policy definitions that are incorporated into the definition of "disability".

The first is known as "own occupation" or "regular occupation". This means that disability constitutes the inability to perform the duties of your usual job. This is the best definition of disability a purchaser of DI can look for – and also the most difficult to get.

Unfortunately, it will also produce the most expensive disability contract, in part because people with marginal claims have been taking advantage of the "own occ" definitions of disability. A bus driver would be disabled if he lost both hands in an accident; a lawyer would be disabled if he lost his eyesight. But, a receptionist could lose a hand, a foot and be blind in one eye and still be able to perform her job: answering phones. This type of disability definition incorporated into a policy is deemed by many insurers to be the best and most difficult to obtain.

Other policies define disability in terms of an individual being unable to perform the regular duties of "any occupation". This means that the policy will consider you to be disabled only if you are unable to work at any job for which you are qualified by education, training and experience.

The third definition falls under "total disability" and it's the shallowest protection of the three. It considers you disabled only if you are unable to work at any job at all. That is, confined to a hospital bed. All three types of policies should protect you from injuries and illness disabilities but sometimes they don t. A few policies called "non-occupational" policies exclude disabilities that arise from the hazards of work on the assumption that you'll be protected by worker's compensation.

What are the different types? But do you qualify?

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