Long-Term Disability Insurance Definitions for Physicians

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Accident

An event that is unforeseen, unexpected and unintended.

Accident Bodily Injury

Physical injury sustained as the result of an accident.

Accident Disability

Either a total or partial disability resulting from an accidental injury.

Accidental Death & Dismemberment (AD&D) Benefit

An optional benefit that provides a fixed lump sum for accidental death or for certain specified actual loss or loss of use of a limb or sight.

Accumulation Period

The length of time (window) where the elimination period or waiting period would need to be filled if they are not consecutive days. It would be very probable where an insured physician would be in and out of work being able to “accumulate” their days out of work to reach the specified waiting period thus triggering a claim. Usually the longer the elimination period, the longer the accumulation period.

Actively-at-Work Provision

An eligibility provision for group benefit coverage whereby an employee is not eligible for coverage if absent from work because of sickness or injury on the otherwise effective date of his or her coverage.

Activities of Daily Living (ADLs)

Generally defined to include eating, bathing, dressing, transferring, toileting and maintaining continence. The inability to perform a certain number of ADLs triggers long-term care insurance benefits.

Actual Age

The age of the applicant the day the application is in completed.

Adverse Selection

The tendency of those who are most likely to have claims to also be those who are the most likely to seek insurance.

Age Nearest Birthday

The age of the applicant at the nearest birthday.

Agent

Insurance company representative licensed by the state, who solicits, negotiates, or affects insurance contract and who provides services to policyholders for the insurer.

Aggregate Indemnity

The maximum amount that may be collected for any disability or period of disability, under an insurance policy.

AIB (Automatic Increase Benefit)

An optional benefit that allows a policyholder to increase his or her disability coverage without evidence of insurability.

Americans with Disabilities Act (ADA)

A federal law designed to make it possible for disabled persons to join the mainstream of everyday life. The act makes it unlawful to discriminate on the basis of disability against a qualified individual with respect to any term, condition, or privilege of employment.

Annual Renewable Term (ART) Policy

A policy that is renewable annually and where the premium may be increased on the same basis. Also called ARDI (Annual Renewable Disability Insurance).

Association Group

A group formed from members of a professional or trade association for insurance under one master insurance contract.

Association Group Disability Coverage

A hybrid of group and individual coverage. AMA has created such plans to attract new members and add value. Plans are typically guaranteed renewable plans requiring membership fees to maintain association coverage. Premiums for such plans are age banded (increase in cost as the physician ages) and can increase on an unscheduled basis. It is inadvisable to have all disability coverage in such a plan because they are fairly volatile in premium and usually lack in strong quality verbiage to maintain lower premiums. Further the plans are not guaranteed renewable, are cancellable and limit Own Occupation claims.

Attending Physician Statement (APS)

The APS is a report written by the insured’s doctor that documents his or her past and current health history. Insurance companies use this report to review applications for insurance and/or to evaluate benefit eligibility, in the event of a claim.

Automatic Increase Benefit

This policy provision increases the policy benefit on an annual basis without evidence of medical or financial insurability. This provision helps the benefit level keep pace with the rising cost of living.

Beneficiary

A beneficiary is a person or entity who is named to receive proceeds or benefits from an insurance policy. There are three types of beneficiaries. Primary beneficiaries (such as a spouse) are first entitled to the proceeds. Secondary beneficiaries (such as a child) are entitled to the proceeds if the primary is no longer living when the insured dies. And, tertiary beneficiaries (such as a grandchild) receive the proceeds if both the primary and the secondary beneficiaries are no longer alive when the insured dies.

Benefit Period

The length of time a disability benefit would pay if disabled, typically to age 65 or 67. Some plans are still issuing benefits periods of LIFETIME, a benefit would pay as long as you are alive and disabled.

Benefit Percentage

A benefit percentage is the amount payable to the insured, based on a percentage of the insured’s income prior to disability. The proceeds are limited to an overall maximum amount.

Benefit Schedule

The listing of the insureds choice of benefit period, elimination period, monthly benefit amount and maximum benefit payable in a disability policy. Also includes any optional benefits.

Binding Receipt

A receipt given for the premium payment made with an application for insurance. If the policy is approved, the payment binds the company to make the policy effective from the date of receipt.

Broker

A person licensed by the state who places business with several insurance companies. The broker represents the consumer rather than the insurance company.

Business Buyout

A policy designed to provide funds to effect a buyout of a disabled owners share of the business, usually dictated by the provisions in a specific buyout agreement.

Business Overhead Expense Insurance (BOE)

Pays the overhead of a medical practice if disabled so the physician doesn’t have to use personal savings or disability benefit to pay bills. These plans have shorter benefit periods of 12 to 24 months to dovetail with pre-established practice agreements or long term leases and allow enough time for the disabled physician to determine if he or she is going to recover or needs to dissolve the practice after health status is firmly determined. This type of coverage is also tax-deductible as a business expense, making it even more affordable and far less expensive than a traditional disability income policy.

Buy-Sell Policy

A buy-sell policy pays a lump sum or installments to the insured’s corporation or business partner to buy out the business interest of the disabled owner.

Cancelable Policy

An individual disability policy in which the insurer retains the rights to increase the premium or cancel the policy, usually only at renewal time.

Capital Sum

A lump-sum amount that is paid in addition to the monthly disability benefit for presumptive loss.

Carry-Over Account

Used in Business Overhead Expense policies, this account accumulates unused benefits so they carry-over and can be used by the insured later.

Cash or Accrual Method

To collect benefits for a partial disability under the residual provision, the insured must show proof of loss of earnings (15 to 20%). The insured can choose one of two accounting methods to determine monthly earnings – either cash or accrual. The same method must be used at all times for any one disability.

Cash Value Rider

If a policy contains a cash value rider, it builds cash value. The cash value typically reaches 100 percent at age 65. (Availability Limited by States)

Claim Examiner

The individual who evaluates a claim to determine if it should be paid.

Claim Reserve

A specific reserve established at the time a claim occurs (or soon thereafter) that anticipates the amount of future claim payments.

Commencement Date

The commencement date is the first day a disability is covered. It immediately follows the completion of the waiting period.

Concurrent Disability

Policy provision that that usually provides that benefits will not be paid for both injury and sickness during any period of disability.Also, any period of disability that results from one or more causes is usually considered a single period of disability.

Conditional Receipt

A term used to describe the immediate activation of physician disability coverage in exchange for a premium assuming medical requirements are met and all underwriting qualifications are met. If the insured becomes disabled in this window of time before approval of a policy, the benefit would be paid (assuming the definition of disability is met) if health status before the claim would have permitted an approval of a policy.

Continuous Disability

A continuous disability occurs when recurrent periods of disability stem from the same cause and are separated by less than 12 months of recovery.

Conversion Privilege

A conversion privilege allows employees who are leaving a job to keep some or all of their LTD coverage without having to submit evidence of insurability. This is done at the employee’s expense. It also allows Business Overhead Expense policyholders to convert to individual DI policies if and when their needs change.

COLA (Cost Of Living Adjustment) Rider

An enhancement to a disability plan that would increase the monthly benefit by the CPI not to exceed a ceiling of typically 3% or 6% compounded or simple interest per year during a claim. This would only be triggered during a claim so it becomes important to keep disability benefits up to date through annual reviews. This rider is designed to prevent inflation from eroding at your benefit.

Covered Expenses

This is a list of expenses that are covered and reimbursable during an insured’s period of disability.

Cross Purchase Agreement

Used in circumstances when there are two business owners, this agreement allows owners to be both the owners and the beneficiaries of a buy-sell policy.

Disability

That portion of the disability contract that defines the circumstances under which the insured is considered to be disabled and benefits are payable.

Disability-Based Policy

A long-term care insurance policy with a per diem basis of payment that provides benefits even if no care is being received as long as the insured satisfies the policys benefit trigger.

Disability Benefits

The amount of weekly or monthly disability payments that are paid in the event of disability.

Disability Case Management

A comprehensive set of procedures and functions to ensure that a disabled policyholder is able to return to work as soon as reasonably possible.

Disability Income

The monthly benefit received by the insured to help replace lost earnings during his or her period of disability.

Disability Insurance

Disability insurance is a type of health insurance which pays the insured a monthly benefit, replacing earnings lost from an accident or sickness.

Effective Date

The effective date is the day the policy begins.

Eligibility Period

The time following the eligibility date during which a member of a group may apply for insurance without evidence of insurability.

Elimination Period (Waiting Period)

The length of time a physician would need to be disabled before entering into a claim scenario. The longer this period, the lower the premium since this essentially is a deductible.

Employment Benefit Programs

A variety of benefits that an employer may provide for employees, such as medical, disability and retirement benefits.

Entire Contract Clause

A provision in a group insurance contract stating that the insurance policy, the policyowners application that is attached to the policy, and any individual applications of any insured person constitute the entire insurance contact.

Entity Plan

The type of buy-out plan in which the business itself, a separate entity is paid the disability benefits under a disability buy sell agreement.

Evidence of Insurability

Statement or proof of physical condition and/or other factual information affecting a persons eligibility for insurance.

Exclusion

This details the risks the insurance company wouldn’t cover a physician for resulting in no benefits paid. A very common exclusion most carriers are excluding are disabilities caused from war and mental/nervous disorders & preexisting conditions. There are still a few companies willing to not excluded for any mental/nervous disorders.

Financial Underwriting

A method of evaluating earnings and other financial data to determine an insured’s appropriate monthly benefit.

Functional Capacity Evaluation

An examination by a medical or clinical professional to determine the extent or degree of a specific disability.

Future Increase Option or Future Purchase Option Rider

This allows a physician to increase their Disability policy by the stated Monthly Maximum amount purchased without having their health re-examined by an Insurance Company on the anniversary date. This is a very important rider for newer physicians wanting to protect a projected higher income since their health status could change, in the future, making them ineligible for increased coverage without this rider. A physician would still need to prove their larger income through W-2s and/or tax returns to qualify for the increased coverage.

Grace Period

A grace period is the 31 days immediately following the due date of a premium. The policy will continue during the 31 days, but if the premium is not paid by the end of the grace period, all coverage will be terminated.

Group Disability

Disability coverage that covers a group of physicians. Usually “initially” inexpensive since the definitions and premiums can change on an annual basis. Most these plans are not portable to a new occupation or practice.

Guaranteed Standard Issue (GSI)

For larger medical groups some insurance companies are willing to issue individual disability insurance without having to place a physician through medical or financial underwriting. With larger pools of physicians an insurance company will consider such an offer so that to avoid adverse selection. Adverse selection is an undiversified group of risk removing normal statistical risk profiles.

Guarantee of Insurability

A policy option that allows the insured to increase the monthly benefit at specified dates. Only a review of financial insurability is required.

Guaranteed Renewable

A characteristic of a disability plan that prevents the insurance company from changing the definitions or cancelling the plan. They do reserve the right to change the premium for a given class of insured’s. Most association group coverage plans are guaranteed renewable.

Income Replacement Plans

A term synonymous with disability income and one that protects an insured against a loss of income due to disability.

Incontestable Clause

A standard individual policy clause whereby the insurer may not contest the validity of an insurance contract after it has been in force for two (sometimes three) years.

Indemnity

The amount of weekly or monthly disability benefits.

Individual Disability Insurance

A plan to protect a physician’s income from an injury or sickness. Usually these plans are fully underwritten meaning a physician would need to prove their health and income to be an acceptable risk to the insurance company. Usually these plans once activated are guaranteed never to change in premium or definitions for the life of the policy usually to age 65 or 67.

Indexing

A provision, which increases the insureds pre-disability earnings level every year after the first year of disability. It can also be a disability product provision or option that annually increases the disability monthly benefit each year over a five-year period, prior to a period of disability.Sometimes referred to as Automatic Annual Benefit Increase.

Individual Insurance

A policy that provides protection to a policyholder. Sometimes referred to as personal insurance, as distinct from group insurance.

Inspection Report

A specific third-party investigation that may be requested during the underwriting or claim process to verify income, occupation or personal activities.

Insurable Income

That part of an individuals gross income that is insurable for disability income purposes (Goss income business expenses).

Insuring Clause

The clause in the disability insurance contract that broadly outlines the contracts terms.

Integrated Disability Management

A single program to manage all of an employers disability claims, regardless of whether they are covered under shot-term plans, long-term plans or workers compensation.

Injury

An injury is any accidental bodily injury sustained by the insured after the policy effective date and while the policy is in force.

Issue Limit

The amount of monthly benefit an insurance company would be willing to place on a physician with a specified income. Each insurance company sets their own issue limit for a given medical specialty and income.

Key Person Policy

A policy specifically designed to provide benefits to a business for the loss of a key employee from disability.

Legal Reserve

The minimum reserve, as calculated under the state insurance code, which a company must keep to meet future claims and obligations.

Lifetime Disability Benefit

Policy provision making benefits payable for the insureds lifetime as long as the insured is totally disabled.

Long-Term Disability Income Insurance (LTD)

A group disability policy that provides disability benefits, usually for more than one year and up to retirement age.

Loss of Income Insurance

A term synonymous with disability income insurance where a loss of income is required before benefits are paid.

Loss Ratio

The ratio of claims divided by premium; may refer to either a cash or incurred loss ratio.

Maximum Benefit Period (Benefit Duration)

The maximum benefit period is the longest length of time benefits are payable as long as the employee remains continuously disabled.

Maximum Monthly Benefit

The maximum monthly benefit is the most a disabled employee can receive on a monthly basis.

Medical Examination

A medical examination and report are often part of the application process for disability insurance policies. The information becomes part of the contract and is attached to the policy.

Medical History

The specific account of an individuals medical history, either given on the insurance application or in a medical examination.

Medical Underwriting

A method of evaluating an applicant’s health and medical history to determine if a policy will be issued and if so, the appropriate rates and exclusions.

Mental and Nervous Condition

Any disability caused by or related to a mental or nervous disorder is often limited in coverage by long-term disability insurance policies. Contracts include a definition of mental and nervous disorders and the insured must meet that definition in order to receive benefits. A major gray area, there are many interpretations and opinions of the terms.

Properly deemed: If a policy’s language is restricted, such as “disability due solely to a mental and nervous disorder,” then the limitation can be invoked only when a disabling condition is due only to the mental or nervous condition. However, if a policy states that the limitation will be applied if the condition is “caused by or resulting from” or “caused or contributed to by” the mental or nervous condition, the insurer may limit benefits.
Definition: If a policy limits coverage for mental or nervous disorder disabilities, it should also contain a definition or the term “mental and nervous disorder.” The definition should include whether there is a cause of the disability, what the symptoms are, and the form of treatment.

Minimum Monthly Benefit

Typically, there is a minimum amount paid as a monthly benefit after reductions are taken for other income benefits.

Minimum Residual Benefit

Under the residual disability provision, the minimal residual benefit provision typically stipulates that during the first six months of disability, the insured must be paid at least 50 percent of the total disability benefit.

Modified Own Occupation

A less liberal definition of “own occupation” language where a benefit would be paid as long as the physician is unable to perform the material and substantial duties of their occupation and isn’t by choice working in another occupation. If the physician elects to work in another occupation then the new occupation income would offset the disability benefit by a predetermined formula.

Morbidity

The frequency and length of time that a group or class of individuals are disabled or may be expected to be disabled.

Mortality

The probability of when individuals in a group or class may be expected to die.

Monthly Benefit

The amount of money paid to a physician that has met the definition of disability for the respective insurance company.

National Association of Insurance Commissioners (NAIC)

An association of the Insurance Commissioners of the 50 states.

Net Earned Income

Gross earned income minus unearned income minus business expenses.

Net Worth

This figure is used in financial underwriting to determine an appropriate benefit amount. It includes the total non-business related assets of an insured.

NON-CAN (Non-Cancelable)

A characteristic of an individual disability plan that prevents the insurance company from changing the premium or definitions for the length of the benefit period.

Noncontributory Plan

An employee benefit plan under which the employer pays the entire cost of coverage.

Non-Disabling Injury

An injury that may require medical care, but does not result in the loss of working time or income.

Non-Medical Limits

The amount above which a disability insurer requires a paramedical or full medical examination.

Notice of Claim

The form required by the insurance company and specified in the policy provisions that notifies the insurer of a potential claim.

Occupation Class

An underwriting category in which insureds are placed based on their specific, customary job duties.

Optional Benefit

Optional benefits are usually available in the form of riders. They add additional coverage to the basic policy.

Optional Renewable Policy

A disability policy that grants the insurer the right to terminate a policy on any anniversary, or in some cases, on a premium date.

Outline of Coverage

Insurance companies usually provide policyholders with an outline of coverage that summarizes the benefits provided.

Overhead Expense Insurance

Insurance for business owners (and professionals) to help offset continuing business expenses when the owner is disabled.

Overhead Maximum

In Business Overhead Expense policies, the Overhead indicates the maximum benefit payout. It is calculated by multiplying the monthly benefit by the number of months in the benefit period.

Overinsurance

A circumstance where the total amount of disability insurance available to an individual from all sources exceeds the insurers issue limits.

Own Occupation

A term used to describe the more liberal disability contracts available to physicians. With “own occupation” language, if a physician cannot work in his or her occupation because of sickness or injury then they would receive a monthly benefit regardless if they were working in another occupation. There would be no offset from monthly disability benefits from earnings in a new occupation.

Paramedical

An insurance medical examination, usually performed by a nurse or technician, that typically includes medical history, blood pressure, urinalysis and perhaps a blood profile, but not a physical examination.

Partial Disability (Residual)

This definition is what triggers a claim if a physician is not totally disabled but partially disabled. Every disability contract should have some form of partial disability rider verbiage since the majority of claims enter into this type of claim.

Participation Limit

The amount an insurance company will participate in the overall disability income protection program for a physician. The participation limit is set for each carrier for and is further broken down by medical specialty. The participation limit would look at the total coverage from group, association, and individual coverage. Insurance companies work together through the use of participation limits to prevent a physician from having more benefit than he or she actually has in income if we look at the NET disability benefit paid after taxes.

Pension Completion Riders

Optional benefit provision that will assure the continuation of contributions to the insureds pension plan during a period of disability.

Permanent Disability

A total disability where the individual is not expected to return to work.

Physical Impairment

A physical condition or abnormality that may result in a substandard underwriting decision.

Portability

The ability to continue employer-provided or employer-sponsored benefits after termination of employment.

Pre-Disability Earnings

The pattern and amount of earned income that a disabled policyholder received prior to his or her disability.

Pre-existing Condition

A condition affecting the probability of claim being paid whereas the insurance company is unwilling to cover since it was a health condition before the insurance was applied. This is something most common to the group disability insurance and guaranteed standard issue (GSI) insurance market.

Premium

A premium is the periodic payment required to keep an insurance policy in effect.

Premium Mode

The premium payment frequency selected by the insured. Most insurance companies offer annual, semi-annual, quarterly or monthly payment modes.

Presumptive Disability

A physician would be presumed totally disabled if these conditions are met even if they could work in some capacity. The loss of sight, limbs, or speech would be examples of a presumptive disability but differ with each insurance company.

Recovery Benefits

The benefit an insurance company would pay a physician who is recovering from a total or partial disability. It can come in the form of lump sums of money or a temporary richer payment of residual disability benefit. Since most disability claims end up in a residual payment, it is very important to understand how this rider would perform and compare it to alternate carriers.

Recurrent Periods of Disability

Recurrent Disability

A physical or medical condition that reoccurs and causes disability.

Recurring Claim Provision

A provision in disability insurance policies that specifies a length of time during which the recurrence of a condition is considered to be a continuation of a previous period of disability.

Regular occupation

The occupation being performed at the time of claim. Similar to Own Occupation.

Rehabilitation

The process whereby an individual who has been disabled is able to return to gainful employment.

Rehabilitation Benefit

Insurance companies are willing to provide special rehabilitation benefits to assist a physician in a better way of life during and after a disability. This usually helps the physician get back to work sooner causing less grief on the overall financial picture and family.

Reinsurance

The process whereby an insurance company insures all or a portion of a specific insurance policy with another insurance company.

Relation to Earnings Clause

A disability policy clause that can adjust the benefits payable based upon the ratio of total benefits for which the claimant is eligible in relation to his or her income at time of disability.

Replacement Ratio

The ratio of disability benefits to income.

Resident Disability Coverage

Physicians in residency are eligible for a preset amount of disability coverage regardless of income, only need to prove their health insurability to an insurance company to acquire coverage. This would be portable so that when they finish fellowship or residency they have coverage immediately
at the new practice setting.

Residual Disability

Not totally disabled but the physician has some loss of time or duties and loss of income, usually at least 20% but some will go down to only 15%. This is generally a more liberal definition than partial disability since you usually don’t have to be totally disabled during the elimination period to qualify. This is a rider available on all quality disability plans and should always be considered since a physician might not ever be totally disabled only residually disabled.

Retirement Protection Plus (RPP)

RPP is not a pension plan or a substitute for one; it is a disability insurance program specifically designed to help protect retirement plan contributions. To qualify for benefits, you must be totally disabled and not gainfully employed. Retirement Protection Plus is designed to help you maintain a healthy retirement strategy by replacing contributions made to a defined contribution plan during a disability. Once eligible for benefits, a monthly benefit insuring up to 100% of your retirement contributions, including any employer-matching contributions, will be paid into a trust established by you. The trustee invests benefits at your direction.

Return of Premium

An optional benefit on an individual disability policy that returns all or a portion of the premium depending upon claim experience.

Return to Work Benefit

A benefit (sometimes optional) that provides additional or temporary benefits as an incentive for an individual to return to work following a disability claim.

Risk Classification

The underwriting process that determines how to consider an applicant from an occupation, avocation, income and health perspective.

Rider

A rider is any extra agreement that is part of the policy that expands or limits the policy’s conditions, coverage or benefits.

Salary Continuation Plan (Section 105 Plan)

Disability insurance that includes certain federal regulatory requirements in order to qualify for favorable tax treatment.

Schedule Page

The specific part of the insurance contract that details the policys benefits, extra benefits and premium.

Short-Term Disability Insurance

Group disability Insurance that provides benefits for loss from accident or injury generally no longer than one year in length.

Sickness

Illness or disease, which first manifests itself after the policy has been issued.

Simplified Issue

Group insurance coverage that is issued with satisfactory responses to questions on an abbreviated application form.

Smoker Rating

Policy applicants who use tobacco produces are subject to a higher premium rate, called a smoker rating. Those who do not smoke or use tobacco products are given a lower premium rate. If an applicant smoked in the past, but has quit more than a year ago, most insurers will still consider the applicant as a nonsmoker. Nicotine can be detected in routine screening tests commonly required by most insurance companies.

Social Security Substitute Rider

Social security has a disability benefit if totally disabled but would require that a physician is unable to perform ANY occupation to qualify for a benefit. The definition of being disabled for social security is the hardest to qualify for. A physician can reduce the premium for their disability coverage if this rider is added since it would offset the benefit from the insurance company if social security benefits pay. If the physician didn’t qualify for social security but met the definition for the insurance company for a claim then there would be no offset. The disability benefit available through social security is dependent upon past income and will show on the annual social security statement.

Social Security Offset Provision

A Provision in group long-term disability policies that allows the insurance benefits to be reduced by the paid or anticipated Social Security benefits payable to the disabled insured.

Split Dollar Plan

A plan that splits premium payment between employer and employee so that part of the disability insurance monthly benefit is taxable and part is nontaxable.

Specialty Coverage

Some insurance companies will liberalize the definition of total disability to address medical specialties. This is what we call a “specialty” definition of total disability. The verbiage in the plan would read so that if a physician has limited their practice to a single recognized specialty that they will deem that specialty to be their occupation. This is very unusual and rare language to find in a disability contract.

State (Compulsory) Disability Plan

A plan of short-term income replacement required by some states to cover eligible persons employed within that state. (See Cash Sickness Benefit)

Step-Rate Plan

A plan under which young insureds (usually professionals) pay a lower premium during the first years of policy ownership and their careers but allows them to get the full protection they need.

Stock-Redemption Plan

A method of funding a disability buy-out plan.

Student Loan Protection Rider

This rider can help provide peace of mind to those who are early in their professional careers. While your income may be on the rise, it could be several years before your yearly earnings exceed your loan balance – a time when many professionals feel particularly vulnerable to a disability that could force them out of work or practice. Student Loan Protection is specifically designed to protect you during this time by providing an added layer of disability insurance, above and beyond what you might purchase to protect your income.

Substandard Insurance

Insurance issued with an extra premium or special restriction to persons who do not qualify for insurance at standard rates or issue.

Supplementary Health Statement

An additional statement asking specific health or medical questions that is completed and signed by the applicant

Supplementary Monthly Benefit

An additional monthly benefit payable under certain specified circumstances (i.e., an additional benefit payable if the insured is confined in a hospital).

Survivor Benefit

The benefit payable to a named survivor (usually the spouse) upon the death of the disabled insured.

Third-Party Administrator (TPA)

A person or organization hired to provide certain administrative services to employee benefit plans.

Time Limit on Certain Defenses

A specific clause in the disability policy that limits the insurers right after a period of time to deny claim payments based on previous medical history. Similar to Incontestable Clause.

Total Disability

When a physician is unable to perform all the material and substantial duties of their disability policy’s definition of total disability then they would fall into a total disability claim resulting in full monthly benefits.

Transplant Surgery Benefit

A benefit payable if the insured undergoes a transplant of a part of his/her body to another person and as a result, suffers a disability.

Trial Application

An application that is completed on a preliminary basis to determine if the applicant is insurable.

Underwriter

(1) A company employee who decides whether or not the company should assume a particular risk, (2) a company that receives the premiums and accepts responsibility for the fulfillment of the policy contract, or (3) the agent who sell a policy.

Underwriting

The process by which an insurer determines whether or not, and on what basis, it will accept an application for insurance.

Unearned Premium

That portion of a premium already received by the insurer for which protection has not yet been provided.

Uniform Provision Law

A set of laws approved by the various states that standardize certain insurance policy language pertaining to the contractual benefits, premium payments and claim procedures.

Waiver of Elimination Period

Under certain circumstances the elimination period would not need to be met to enter into a claim scenario. This is typically after a physician has entered into a claim scenario and later re-entered because of like causes.

Waiver of Premium

If a physician is being paid a benefit for being disabled totally or partially, the insurance company will waive the disability premium.

Wage Continuation Plan

(See Salary Continuation)

Waiting Period

The time that a person must wait from the date of acceptance into an eligible class (or from application) to the date the insurance becomes effective. The words Elimination Periods are sometimes used to describe a waiting period. However, they have different meanings.

War Exclusion

A policy provision that excludes payment of benefits for disability resulting from an act or accident of war.

White-Collar Occupations

A term that usually refers to non-manual occupations, especially office and clerical jobs.

Workers Compensation

A governmental plan that provides disability benefits when the covered person is totally disabled from an on-the-job accident or sickness.