Individual Disability Policy: Are You Covered?
If you have a professional practice or your are a private business owner, chances are pretty good you have an individual disability policy. When you’re in business for yourself, disability insurance almost is a necessity in order to protect your future, your family’s future and the future of your business.
However, merely having disability insurance alone is not the only consideration. Prior to purchasing a policy you probably should assess your personal and professional needs in order to select the right disability insurance as well as the right amount of it.
For Example . . .
How does your policy define “disability?” If you are in your own practice or business, you should have a policy that will pay you if you can’t perform your occupation. If your policy defines “disability” as being unable to perform any occupation, it becomes far more difficult for you to qualify for benefits. A doctor, for example, who cannot practice medicine because of a disability should be entitled to her benefits even if she IS able to work in another occupation.
Many people are not aware that even though they become disabled, they still are compelled to pay their insurance premiums. While most disability insurance policies waive their premiums during a disability, not all do and many life insurance policies do not.
Therefore, when deciding on how much coverage to buy, it makes sense to consider adding on a Premium Waiver benefit. A Premium Waiver benefit will waive your premiums when you become disabled and continue your coverage. You won’t have to worry about making the payments.
And, as a business owner you also need to consider the effects of your disability on your business. Your personal disability insurance may pay your mortgage and other living expenses, but how will your absence affect your business? Will the work get done without you there, or will your business just cease? It may be prudent to consider purchasing a Business Overhead Policy.
A Business Overhead Policy is one that will pay some or all of your business overhead expenses when you become disabled – a way to secure its smooth, continued operation. For example, it could pay your office rent and other expenses if the business income drops in your absence. Or, if you are a professional in a solo practice, it may pay to hire a temporary replacement to see your clients or patients while you recover.
Other Considerations . . .
1. Once you’ve assessed your needs and have purchased disability insurance, review your policy carefully. Before you ever need it, you should have read all the fine print for rules and limitations.
2. Re-read it often for changes.
3. Finally, if you need anything in your policy clarified, consult with an attorney experienced in disability law.
ERISA: The High Standard of Review
Recently, our firm had that “one for our side” feeling when a magistrate judge ruled that the de novo standard of review be applied to one of our ERISA cases. Although this is not a “win,” it clearly is beneficial to our client. Here’s why.
The ERISA Standard of Review . . .
As we discussed in the last issue, the standard of review in an ERISA case either is arbitrary and capricious or de novo. The arbitrary and capricious standard of review simply means that the plaintiff (or claimant) must prove that the plan administrator or the insurance carrier (sometimes the same entity) acted in an arbitrary and capricious manner. In other words, the judge has to evaluate whether the decision was reasonable or not. The Court is not evaluating whether the carrier’s decision is right or wrong, nor is it deciding if you are entitled to the benefits.
The arbitrary and capricious standard of review is applied when it can be proven that the plan administrator was given the discretion to interpret and construe the terms of the plan. When this is not the case or it is questionable, Courts usually apply the de novo standard of review.
In a de novo standard of review, the Court sets aside the decisions of the claims administrator and evaluates the claim purely on the basis of the evidence. That is, the Court determines if you are disabled or not based on the record before it.
This levels the playing field just a bit for the claimant.
Legislative News . . .
Inspector General to Review VA Military Sexual Trauma Billing Policy Nationwide Due to Akaka Oversight
May 7, 2009 – Washington, D.C., Following discoveries from an initial oversight request by Senate Veterans’ Affairs Committee Chairman Daniel K. Akaka (D-HI), the Department of Veterans’ Affairs (VA) Inspector General (IG) will conduct a national review to determine whether veterans are being inappropriately charged for treatment related to military sexual trauma (MST).
Chairman Akaka requested a review of MST-related billing at the Austin VA outpatient clinic after receiving a letter from a veteran who discovered she was being inappropriately charged for her care. VA’s investigation into that facility revealed that the clinic was, in fact, billing veterans inappropriately for MST-related services and prescriptions. Under existing law, veterans are entitled to free VA treatment for conditions related to military sexual trauma.
“Disabilities resulting from military sexual trauma, physical or invisible, must be treated like other service-connected wounds: VA has an obligation to provide and pay for the care. I am disappointed to find that at least one outpatient clinic was wrongly charging veterans for this type of care, but I commend VA for immediately launching a national review to determine if this problem is occurring elsewhere, so appropriate corrective actions can take place as soon as possible.
“The veteran who notified me about this matter has done a great deed for veterans across this nation. With her help, I was able to notify VA’s Inspector General, whose office conducted this very important review,” said Akaka. Source: www.akaka.senate.gov
History Trivia . . . Who Was This Great American?
He was born in Atlanta, Georgia, January 15, 1929.
He received his doctorate at Boston University.
He become pastor of the Dexter Avenue Baptist Church in Montgomery, AL.
In 1955, he led the Bus Boycott.
At age 35, he won the Nobel Peace Prize.
He was assassinated in Memphis, TN on April 4, 1968.
Answer: Dr. Martin Luther King