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Disability Insurance: Long Term: Group

Recurring Disabilities Provision

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Most plans contain a provision to determine how a second claim is treated if it comes after the person who was away from work on disability has returned to work. This provision determines whether the second claim is a new claim and requires a new Elimination Period or whether it is considered part of the first claim so that benefit payments start immediately. (To learn more, see the Elimination Period, above.)

The typical provision will state that the second claim is a continuation of the first claim if:

  • It is due to the same cause as the first claim, AND
  • The time between the two periods of disability does not exceed a period of time, such as six months.

This means that:

  • If you return to work but can't continue after being back at work for only four months, and the reason is because of the same diagnosis, the claim will be part of the first claim. Benefits will start right away.
  • If you were disabled due to heart problems and returned to work , but the next week you get hit by a car and are disabled due to the accident, then you are faced with a new claim because the cause is different. The Elimination Period must be met all over again.

NOTE: The provisions of an insurance policy are not set in stone. You can negotiate with the insurer to change the terms of the policy if you are not working because of a "disability" and are concerned about returning to work because of the wording of the recurring disabilities provision. For example, the period of time is too short, or your want to go to work for another employer but your policy only applies if you return to work for the same employer. Unless you are experienced as a negotiator, it is preferable to have an experience negotiator such as an attorney negotiate this type of change for you. The discussion with the insurer could trigger a re-examination of whether or not you are still disabled.

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