Disability Insurance: Loss of Limb
Apr 25, 2013
Jamie Fleischner

Jamie Fleischner

25 Apr, 2013

By Jamie K. Fleischner, CLU, ChFC, LUTCF
President, Set for Life Insurance

I have had a lot of calls recently asking me if their individual disability policies would pay them if they lost a limb. The answer is a resounding yes!

Most individual disability insurance policies have a clause called “presumptive total.” This means that under certain conditions, you will be presumed to be disabled and will receive full benefits even if you are still working and are gainfully employed.

Here is some sample language describing the presumptive disability rider:


This rider is part of the policy. It is issued in consideration of the application and payment of the

premiums for the policy to which it is attached. All definitions, provisions, exceptions, limitations, and

other terms of the policy apply to this rider unless specifically changed by this rider. The effective date of

this rider is shown on the Data Page.


PRESUMPTIVE DISABILITY must occur while the policy and this rider are in force and prior to the Age

65 Policy Anniversary or five years after the Policy Date, whichever is later; otherwise, the loss must

occur not more than 30 days after the Injury or Sickness which causes it and which occurred while the

policy and this rider were in force. The Injury or Sickness must result in Your total loss of use for any and

every purpose or activity without any possibility of recovery of:

a) Power of speech; or

b) Hearing in both ears; or

c) Sight of both eyes; or

d) The use of both hands, both feet, or one hand and one foot.


If You meet the definition of Presumptive Disability, We will consider You Disabled and pay benefits for

Total Disability under the Disability Benefit section and Social Insurance Substitute Benefit section

(subject to those sections’ terms and conditions) of the policy, regardless of Your ability to Work or earn

an income.

Benefits will start to accrue when the Presumptive Disability occurs, even if the Elimination Period has not

been satisfied. Monthly benefits will be paid as long as the Presumptive Disability continues, but no

longer than the Maximum Benefit Period. If Your Maximum Benefit Period shown on the Data Page is “to

Age 65 Policy Anniversary”, “to Age 67 Policy Anniversary” or “to Age 70 Policy Anniversary”, the

Maximum Benefit Period will be extended to “Lifetime” for benefits payable under the Disability Benefit


Once We begin paying benefits under this rider, the Regular Care By A Doctor requirement specified in

the policy is waived.

If the Cost of Living Adjustment Rider is attached to the policy, no further increases will be provided under

that rider after the end of the Maximum Benefit Period shown on the Data Page.


This rider terminates on the first of:

1 . Your Age 65 Policy Anniversary or five years after the Policy Date, whichever is later; or

2. Our receipt of the Owner’s written request to terminate it; or

3. Termination of the policy of which it is a part.

If You are Presumptively Disabled and receiving benefits under the Disability Benefit section of the policy

and this rider prior to and continuing through the date specified in number 1 above, then the policy and

this rider remains in force with no further premiums due until the earlier of the end of Your Presumptive

Disability or the end of the Maximum Benefit Period.


For more information about presumptive total disability and/or disability insurance and loss of limb, please contact Set for Life Insurance today!


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