Five questions regarding disability insurance policy by reviewing sample attached. 200 word per question 1000 words


Question Description

1000 words total- Complete the Income Disability Insurance Policy Worksheet in 200 words min per question.

Question: 200 words min per question.

What is the elimination period and it’s the length of time?

What are the exclusions for incarceration?

What is the reinstatement provision?

What is the benefit for total disability?

How long is the appeals period if a claim is denied?

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UoP Life and Accident Insurance Company 1 Phoenix, AZ 85383 AZ SAMPLE, the Insured Policy Number 06-600-95 0970 Disability Income Policy NON-CANCELLABLE AND GUARANTEED RENBIABLE TO AGE 65, NO CHANGE IN PREMIUM RATES. As long as the premium is paid on time, Me cannot change Your Policy or its premium rate until Your 65th birthday. RENEMAL OPTION AFTER YOU REACH AGE 65. SUBJECT TO CHANGE IN PREMIUM RATES. You may continue Your Policy for a Total Disability benefit with a limited benefit period while You are actively and regularly employed a m1n1mum of 30 hours per week. There is no age limit. This option is explained in Part 4. Your Right To Cancel. If you are not satisfied with Your Policy, You may cancel it. Return the Policy to Us or Your authorized representative through whom it was purchased by midnight of the tenth day after the date You receive it. If you return the Policy by mail, it must be properly addressed, postage prepaid, and postmarked no later than midnight of that tenth day. Within ten days after we receive the Policy, We will refund any premium you have paid. The Policy will be considered to have never been issued. Read Your Policy Carefully. It is a legal contract. Signed, President and Chief Executive Officer 600 Vice President, Corporate Secretary and Assistant General Counsel Page 1 TABLE OF CONTENTS Page Renewal Provisions 1 Policy Schedule 3 Part 1 Definitions Part 2 Part 3 Premium and Reinstatement Part 4 Part Exclusions 8 9 •• Renewal Option After Age 65 11 • 5 Claims 12 Part 6 The Contract Part 7 Benefits 15 Part 8 Recurrent and Concurrent Disability 16 A copy of Your application, added benefits You have purchased, and any added provisions are attached at the back of the Policy. 600 Page 2 POLICY SCHEDULE Insured - AZ SAMPLE Effective Date - October 25, 2007 Policy Number - 06-600-9540970 First Renewal Date - October 2,5 2008 Renewal Term - Twelve Months ---------------------------------Summary of Premium--------------------------------Hon-Tobacco User Annual Premium for Disability Benefits Annual Premium for Additional Benefits Total Annual Premium $931.29 $167.30 $1,098.59 Your Annual Premium $1,098.59 Other Premium Paying Methods: $571.27 Semi- Annual $285.63 Quarterly $95.03 Monthly ( Insurematic Bank Draft) --------------------a-b-l-e-o-f Total Disability Benefits------------------------Elimination Period 90 Days Maxi mum Benefit Periods For Total Disability Total Disability Monthly Amount To Age 65 $3,500.00 The Maximum Benefit Periods for Total Disability may change due to Your age at Total Di sabi lity. Please see the Maximum Benefit Periods for Total Disability section of the Policy Schedule. Maximum Benefit Period for Mental Disorders: 24 Months over the life of Your Policy Benefits for Mental Disorders will be payable for the Maximum Benefit Period for Mental Disorders not to exceed the Maximum Benefit Periods for Total Dis ability. Benefits payable beyond the Maximum Benefit Period for Mental Disorders for a hospital conffinement due to a Disability from Mental Disorders will in no event exceed the Maxi mum Benefit Periods for Total Dis ability. Your Occupation Period: 24 Months . A copy of the application(s) is attached and is part of Your Policy. Omissions and misstatements in the application(s) could cause an otherwise valid claim to be denied or Your Policy to be rescinded. We agree to pay benefits subject to all of the provisions contained in Your Policy. You agree to do all that would be reasonably expected to mitigate any loss. Loss must begin while Your Policy is in force. PART 1 - DEFINITIONS THE FOLLOWING WORDS HAVE SPECIAL HEANINGS . THEY ARE IHPORTANT IN DESCRIBING YOUR RIGHTS AND OUR RIGHTS UNDER THE POLICY. REFER BACK TO THESE MEANINGS AS YOU READ YOUR POLICY. Any Occupation means Any Occupation for which You are reasonably fitted based on education, training or experience. Concurrent Disability means a Disability that is caused by more than one Injury and/or Sickness. Contest means that We question the validity of coverage under Your Policy by letter to You. This contest is effective on the date We mail the letter and refund the premium to You. CPI-U means the Consumer Price Inde x for all Urban Consumers. It is published by the United States Department of Labor. If this index is discontinued or if the method of computing is materially changed, We may choose another index. We will choose an index that, in Our opinion, would most accurately reflect the rate of change in the cost of living in the United States. CPI-U will then mean the index We choose. CPI-U Change means the result of a computation we will make as of each Review Date. We will divide the CPI-U for the most recent Index Month by the CPI-U for the Index Month prior to the most recent Index Month. CPI-U Factor means the result of the CPI-U Change as of the current Review Date multiplied by the CPI-U Change for each prior Review Date occurring since the Disability began. The CPI-U Factor as of the first Review Date will equal the CPI-U Change as of that Review Date. The CPI-U Factor is determined as of each Review Date while Disability continues. Disability or Disabled means that You are Totally Disabled or Residually D is abled. Disability must start while this Policy is in force. A Disability begins with an Elimination Period and has a maximum benefit period applied to it. Effective Date means the date that the Policy becomes effec t ive. Policy Schedule. 600 It is shown in the Page 4 Elimination Period means the number of days that must elapse in a Disability before benefits become payable. The number of days is shown in the Policy Schedule. These days need not be consecutive; they can be accumulated during a Disability to satisfy an Elimination Period. Benefits are not payable, nor do they accrue, during an Elimination Period. Hospital means an institution legally operating as a facility that: 1. 2. 3. i s mainly engaged in providing in-patient medical care for diagnosis and treatment of Injury or Sickness, and routinely makes a charge for such care; is supervised by a staff of Physicians on the premises; and provides on the premises 24 hour nursing services by registered graduate nurses. In no event will Hospital include any institution: 1. which is run mainly as a rest, nursing or convalescent home; 2. in which any part is mainly for the care of the aged; or 3. which is engaged in the schooling of its patients. Index Month means the calendar month four months prior to the calendar month in which a Review Date occurs. The first Index Month for any Disability will be the calendar month four months prior to the month that Your Disability began. Injury or Injuries means accidental bodily injury that occurs after the Effective Date and while Your Policy is in force. Insured is named' in the Policy Schedule and is the owner of this Policy. Loss of Earnings for any month means Your Prior Earnings minus Your Monthly Earnings in the month for which a benefit is claimed. This difference will be considered a Loss of Earnings to the extent it is due to the Injury or Sickness that caused the Disability. The Loss of Earnings must be at least 20¾ of Prior Earnings. Maximum Benefit Period for Mental Disorders is the longest period of time for which We will pay benefits for loss contributed to or caused by Mental Disorders. It is shown in the Policy Schedule Maximum Benefit Period far Residual Disability is the longest period of time for which We will pay benefits during a Residual Disability. It is shown in the Policy Schedule. Maximum Benefit Period for Total Disability is the longest period of time for which We will pay benefits during a Total Disability. It is shown in the Policy Schedule. Mental Disorders means any disorder (except dementia resulting from stroke, trauma, infections or degenerative diseases such as Alzheimer's disease) classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, most current as of the start of a Disability. Such disorders include, but are not limited to psychotic, emotional or behavioral disorders, or disorders relatable to stress or to substance abuse or dependency. If the DSM is discontinued or replaced, these disorders will be those classified in the diagnostic manual then in use by the American Psychiatric Association as of the start of a Disability. 600 Page 5 Monthly Earnings means your salary, wages, comissions, bonuses, fees and income earned for services performed. If you own any portion of a business or profession, it means: 1. Your share of income earned by that business or profession; 2. less Your share of business expenses that are deductible for Federal income tax purposes; 3. plus your salary and any contributions to a pension or profit sharing plan made on Your behalf. Monthly Earnings does not include: 1. income from deferred compensation plans, disability income policies or retirement plans; or 2. income not derived from Your vocational activities. We will allow either the cash or accrual accounting method, but during a Disability, the same method must be used when determining Loss of Earnings. Physician means a person who is licensed by law, and is acting within the scope of the license, to treat Injuries or Sickness that results in a Disability. A Physician cannot be You or anyone related to You by blood or marriage, a business or professional partner, or any person who has a financial affiliation or business interest with You. A Physician must be a licensed psychiatrist or a licensed doctoral level psychologist if a Disability is due to a Mental Disorder that is classified in the Diagnostic and Statistical Manual of Mental Disorders (DSH), or its successor, published by the American Psychiatric Association as of the beginning of a Disability. Physician's Care means the regular and personal care of a Physician as frequently as is medically required according to standard medical practice, and which, under prevailing medical standards, is appropriate for the condition causing the Disability. Policy means the legal contract between You and Us. The policy, any application(s), the Policy Schedule(s) and any attached papers that we call riders, amendments, or endorsements make up the entire contract between You and Us. Pre-existing Condition means a sickness or physical condition for which prior to the Effective Date: 1. symptoms existed that would cause an ordinarily prudent person to seek advice or treatment from a Physician; or 2. advice or treatment was recommended by or received from a Physician. Prior Earnings means the greater of Your Monthly Earnings: 1. for the 12 months just prior to the Disability for which claim is made; or 2. for the fiscal year with the higher earnings of the last two fiscal years prior to the Disability for which claim is made. Starting as of the first Review Date, Me will make an inflation adjustment to Your Prior Earnings. Me will multiply Your Prior earnings by the CPI-U Factor. The result will be used until the next Review Date to compute Residual Disability Benefit amounts payable. The inflation adjustment increase will be at least 2¾ of Your Prior Earnings amount. In no event will the inflation adjustment increase be more than 10¾ of Your Prior Earnings amount. 600 Page 6 Recurrent D;sab;1;ty means a Disability that occurs within six months after the end of a previous Disability that is due to the same or related cause. s Residual Disability or Residually Disabled means that You are not Totally Disabled, but due to Injury or Sickness: 1. You are unable to perform one or more of the material and substantial duties of Your Occupation; or You are unable to perform them for as long as normally required to perform them; and 2. You are receiving Physician's Care. We will waive this requirement if We receive written proof acceptable to Us that further care would be of no benefit to You. After the end of the Elimination Period, Residual Disability or Residually Disabled also means: 3. You incur a Loss of Earnings whHe You are engaged in Your Occupation or Any Occupation. Review Date means each anniversary of the start of a Dis ability. Rider Effective Date means the date that the Rider becomes effective. It is shown in the Policy Schedule. Sickness means sickness or disease that first manifests itself after the Effective Date and while Your Policy is in force. It includes Disability from surgery performed to improve Your appearance or prevent disfigurement or to transplant part of Your body to someone else. Total Disability or Totally Disabled means that because of Injuries or Sickness: You are unable to perform the material and substantial duties of Your Occupation; and 2. You are not engaged in any other occupation for which You are fitted by education, training and experience; and 3. You are receiving Physician's Care. We will waive this requirement if We receive written proof acceptable to Us that further Physician's Care would be of no benefit to You. 1. After the end of the Your Occupation Period, then Total Disability also means: 4. You are unable to perform the material and substantial duties of Any Occupation. Total Disability Monthly Amount is shown in the Policy Schedule. Me, Our, and Us refer to The Provident Life and Accident Insurance Company and its affi 1 iates. Mork Incentive Period for Residual Disability is shown in the Policy Schedule. You, Your and Yourself refer to the Insured named in the Policy Schedule. Your Occupation means the occupation or occupations, as performed in the national econo my, rather than as performed for a specific employer or in a specific location, in which You are regularly engaged at the time You become Disabled. Your Occupation Period is shown in the Policy Schedule. 600-TN Page 7 PART 2 - EXCLUSIONS Exclusions We will not pay benefits for a Disability contributed to or caused by: 1. 2. 3. 4. 5. 6. war or act of war, whether declared or undeclared; or the suspension, revocation or surrender of Your professional license to practice in Your Occupation; or normal pregnancy or childbirth during the first 90 days of Disability (We will pay benefits for loss caused by complications of pregnanc.y Complications are physical conditions that physicians consider distinct from pregnancy even though caused or worsened by pregnancy. Examples of conditions that are not complications include false labor and morning sickness.) Your commission or attempt to commit a crime, or Your being engaged in an illegal occupation; or intentionally self inflicted injuries; or any loss We have excluded by name or specific description (any such exclusion will appear in the Policy Schedule). We will not pay benefits for any period You are incarcerated during a Disability. We will not pay benefits for more than 12 months while You reside outside the United States or Canada. You will be considered to reside outside these countries when You have been outside the United States or Canada for a total period of 6 months or more during any 12 consecutive months during a Disability. Pre-existing Conditions Limitation We will not pay benefits for a Disability caused by a Pre-existing Condition that was not disclosed, or that was misrepresented, in answer to a question in the application for this Policy. A Pre-existing Condition 1) that was disclosed and not misrepresented in the answer to a question in the application, or 2) about which a question was not asked on the application, will be covered frmo the Effective Date shown on the Policy Schedul.e The Insured is responsible for verifying the accuracy of each and every statement in the application. Page 8 PART J - PREMIUM AND REINSTATEMENT Payment of Premium The first term of this Policy starts on the Effective Date shown in the Policy Schedul.e It ends on the First Renewal Date. Later terms are periods for which You pay renewal premiums. All terms will begin and end at 12:01 A.H., Standard Time at Your home. You continue the Policy in force from term to term by paying premiums when due. The renewal premium for each term is due on the day the preceding term ends, subject to the grace period. Premiums may be paid annually or semi-annually. If Our rules permit it, You can pay the premiums quarterly or monthly. We will allow You to change this by written request. But, We will not allow a change while You are Disabled. Grace Period After the first premium has been paid, a grace period of 31 days i s allowed for late payment of premium. Your Policy will remain in force during the grace period. If the premium is not paid when it is due or within the grace period, the Policy will lapse. Reinstatement If a renewal premium is not paid before the grace period ends, the Policy will lapse. You may apply to reinstate this Policy within six months from the date of the Policy lapse by: 1) completing an application for reinstatement and 2) paying the full amount of overdue premium. You will be given a conditional receipt for the premium tendered. If Your application is approved, the Policy will be reinstated as of the approval date. If We fail to act on Your application (by approving or disapproving it) within 45 days from the date of the conditional r-eceipt, the Policy will be reinstated on that 45th day. If We or one of Our authorized representatives accept the overdue premiums without requiring an application for reinstatement, the Policy will be reinstated. The r-einstated Policy will cover only loss that results from Injuries that occur after the date of reinstatement or Sickness that occurs more than 10 days after that date. In all other respects, Your rights and Ours will remain the same, subject to any provisions noted on or attached to the reinstated Policy. Premium Refund We will make pro-rata refunds of premium: 1. in the event of Your death (such refunds will be made to Your estate for any premium paid for a per-iod beyond the date of Your death.); 2. if the Policy terminates because You stop wor-king (except because of Injury or Sickness) when this Policy has been c·ontinued after Your 65th birthday, or if later, after it has been in force for five years; 3. if You suspend Your Policy in accordance with the Suspension During Military Service provisi on; or 4. in accordance with the Waiver of Premium provisio n. 600-TH Page 9 Suspension During H;1;tary Serv;ce If You enter full time, active duty in the military (land, sea, or air) service of any nation or international authority, You may suspend this Policy. However, You ...
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School: University of Maryland



Disability Insurance Policy
Institution Affiliation




Disability insurance policy is a cover that is intended to replace a significant portion of an
individual's income when injury or sickness prevents him/her from earning a living. The policy
can assist in payment of monthly bills that are regular while an individual is in the recuperating
period but is still not in a position to continue doing his/her job. In the case of a disability, for
instance, after an accident, the policy covers the expenses as well as loss of income. There are
two types of disability insurance; the short-term which replaces a part of the paycheck for a short
period, that is, around three to six months and the long-term which provides coverage when an
individual is not in a position to work for an extended period, that is years up to even decades.
Policy Elimination Period and Its Length of Time
Elimination period in the disability insurance policy is the number of days that must pass
in disability for the benefits to be payable. The days must not be consecutive, and benefits do not
accrue during this period. The length of this period is usually 90 days as shown in the policy
schedule. This period means that the insurer must have stayed with the disability for at least 90
days for him or her to get the benefits. If an insurer decides to have a shorter elimination period,
he/she is charged a higher rate. The maximum length of time is 720 days, and the shortest is 30
days. However, although the short period has a high cost, a longer elimination does not save the
insurer as much money due to the risk involved. It is crucial to understand that when the
elimination period is satisfied, actual benefit checks are received at the end of the month (High
Income Protection Insurance, no dates). For a 90 day elimination period, one w...

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