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The short-term disability insurance policy is a contract. And you must follow the terms of this contract in order to get your benefits. The first section talks about claim provisions. You must file a notice of a claim with this insurance company within 31 days.
These policies have deadlines all over the place, and this is one of your first deadlines. A notice of claim must be filed within 31 days of the date you are claiming that your disability began and caused you to be unable to work. That’s the very first thing, a notice of a claim.
The definition of disability
Usually, the definition of disability is right at the very beginning. But I’m going to highlight a few things here. Let’s look at the schedule of benefits. This is what I talked about regarding the eligibility period and the elimination period.
In this particular policy, the definition of disability is, “If you are unable to perform the material duties of your regular job.” That’s a very standard definition of disability. Of course, there are a few things to look at here. What are material duties? And what is your regular job?
When something is not bolded or capitalized, then that means there’s no definition for it. So in this particular policy definition for disability, the term material duties is not defined, which means that you can tell the insurance company what your material duties are. Usually, that’s from your own job description.
Your regular job
The phrase “your regular job,” though, is a defined term in the policy. And it’s tricky. This one trips up clients all the time. The regular job, as defined in the insurance policy, is, “The job that you were doing when you became disabled as it is normally performed for the employer.”
Sometimes, though, it says something a little bit different. So, for example, for this policy, “As it is normally performed for the employer,” means how you perform your actual job for your employer.
However, sometimes, the policy definition for regular job or our own occupation is defined as a job, “as it is performed in the national economy.” That definition is more common. As a result, your policy may provide that your own occupation or regular job is, “As it is performed in the national economy.”
But what if your employer required you to travel 20 hours a week even though the occupation that you have typically does not require travel. Or your employer required you to work 60 hours a week while normally that job is only a 40-hour a week job.
In either case, you have to show that your disability prevents you from doing the job even if it is performed in a lesser way in the national economy. So, that is the definition of disability.
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