What Qualifies as a Disability for Insurance Claims?

When it comes to insurance claims, the definition of disability can vary depending on the type of insurance policy and the specific terms outlined within it. Generally, a disability is considered a condition that significantly impairs an individual’s ability to perform their job or daily activities.

Understanding Disability Insurance Qualifications

The following are some key factors that typically qualify as a disability for insurance claims:

• Medical condition—The individual must have a medically determinable physical or mental impairment. This can include chronic illnesses, severe injuries and mental health disorders.

• Duration—The impairment must be expected to last for a significant period, usually at least 12 months, or result in death. Temporary conditions that resolve within a short period typically do not qualify.

• Severity—The condition must be severe enough to prevent the individual from performing substantial gainful activity. This means the person is unable to engage in work that earns above a certain income threshold.

• Documentation—Proper medical documentation is crucial. This includes medical records, doctor’s reports and any other relevant evidence that supports the claim of disability.

• Policy terms—Each insurance policy may have its own criteria for what constitutes a disability. It’s important to review the policy details to understand the exact requirements.

Common Reasons Disability Claims Are Denied

Disability insurance claims can be denied for various reasons. The following are some of the most common ones:

• Insufficient medical evidence

• Noncompliance with treatment

• Failure to meet Policy definitions

• Engaging in substantial gainful activity

• Incomplete or inaccurate applications

Learn More

For disability insurance near you, contact Morais Agency.

This blog is intended for informational and educational use only. It is not exhaustive and should not be construed as legal advice. Please contact your insurance professional for further information.