Understanding Your Benefits

Own Occupation

The occupation trade or profession you were employed in prior to your disability as defined by the US DOL Dictionary of Occupational Titles.

Total Disability

You are considered totally disabled if, due to an injury or illness, you are unable to perform each of the main duties of your own occupation. Your “own” occupation is covered for a specific period of time. Following this, the definition of total disability becomes the inability to perform any occupation for which you are reasonably suited based on your experience, education, or training.

Partial Disability

You are considered partially disabled if you are unable, due to an injury or illness, to perform the main duties of your regular occupation on a full-time basis. Partial Disability benefits may be payable if you are earning at least 20% of the income you earned prior to becoming disabled, but not more than 99%. Partial disability benefits allow you to work and earn income from your employer as well as continue to receive benefits, which may enable you to receive 100% of your income during your time of disability.

Continuation of Disability

If you return to work full-time but become disabled from the same disability within six months of
returning to work, you will begin receiving benefits again immediately.

Benefit Duration Reduction

Your benefit duration may be reduced if you become disabled after age 65.

Pre-Existing Condition

Any sickness or injury for which you have received medical treatment, consultation, care, or services (including diagnostic measures or the taking of prescribed medications) during the specified months prior to the coverage effective date. A disability arising from any such sickness or injury will be covered only if it begins after you have performed your regular occupation on a full-time basis for the specified months following the coverage effective date, unless no treatment was received for the specified consecutive months after the coverage effective date.

Benefit Exclusions

You will not receive benefits in the following circumstances:

• Your disability is the result of a self-inflicted injury.
• You are not under the regular care of a doctor when requesting disability benefits.
• You were involved in a felony commission, act or war, or participation in a riot.

Benefit Reductions

Your benefits may be reduced if you are receiving benefits from any of the following sources:

• Any compulsory benefit act or law (such as state disability plans);
• Any governmental retirement system earned as a result of working for the current policyholder;
• Any disability or retirement benefit received under a retirement plan;
• Any Social Security, or similar plan or act, benefits;
• Earnings the insured earns or receives from any form of employment;
• Workers compensation;
• Salary continuance or employer contributions to an employer sponsored retirement plan.

Benefit Termination

This coverage will terminate when you terminate employment with this policyholder, or at your retirement.