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:
PRESUMPTIVE DISABILITY BENEFIT 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.
PRESUMPTIVE DISABILITY BENEFIT
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
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!