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CHAPTER 12

says that you are considered disabled if you cannot perform at least one primary duty of your own job. Under this rule, a surgeon who has lost his or her motor skills and could no longer operate would receive full benefits even though he or she could still meet with patients and consult with other surgeons and doctors. However, you can opt for a residual benefit feature, which would pay you partial benefits if you could only work for a lower salary or part-time.

Most policies use a stricter definition of disability, known as the “any occupation” interpretation. Under the any occupation def- inition, a person is considered disabled if he or she is unable to per- form any occupation for which that person is reasonably suited or trained for. The basis for this is the individual’s education, training, or work experience. This type of policy is considerably less expen- sive because it gives the insurer the leeway of determining whether benefits should be paid.

Some types of individual policies include a presumptive clause, which allows the insurer to discard the any-occupation and own- occupation rules. This clause states that the insured is presumed to be totally disabled under certain conditions, such as loss of both hands or feet, loss of eyesight in both eyes, or loss of hearing in both ears. Through this clause, the insured would receive full benefits even though they may choose to remain employed.

Social Security DI There are two main types of social security DI benefits: cash dis- ability income benefits, and the freezing of a disabled worker’s wage position in order to determine that person’s future retirement or survivorship benefits. A worker is considered eligible to receive benefits when he or she has a medically determined physical or mental impairment that is very severe. The impairment must be so severe that the worker must be deemed unable to engage in any sub- stantially gainful work or employment. Any substantially gainful work amounts to what is termed an “all occupations” definition. That is, you can’t be able to do anything for pay. Nothing. Not only is that definition difficult to fulfill, the rules about it are very strict.

If you become disabled and have satisfied the unable-to-work provision, you must then wait 5 months before you can collect any

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