Availability is subject to underwriting and state approval.
What defines disability?
Individual disability insurance offers choices when it comes to the definition of disability. The base policy definition is generally the "modified" own-occupation type, where, due to injury or illness, a person is disabled if they are unable to perform material and substantial duties of their own occupation and not working. The not working requirement can be waived, for additional cost, by adding a true occupation rider or residual/partial loss of income rider to the policy, which offer work choices.
True own occupation permits a disabled person - while on claim - to moonlight in a different occupation without disqualifying themselves or reducing benefits, thereby creating a path to full income replacement.
Residual/partial loss of income disability riders offer another path to qualify as disabled if working but not earning as much as before. Crucially, this definition permits a person to work any way they want to - including one's own occupation. The advantage of this definition is to shift the focus away from whether a person can work in their occupation to the earnings itself...which is the entire point, after all.
Residual/partial loss of income disability riders add reliability and choice, especially for performance-sensitive occupations where earnings are driven by cognitive skill rather than physical capacity. Examples include attorneys, consultants, software developers, executives, and sales positions. In these professions, the ability to work is too crude a test. In fact the earnings of many sedentary occupations are driven by slight competitive differences in cognition and personality where ability to work is not even going to be in question. If earnings vary widely between individuals in the same occupation, that's a strong indication that a favorably worded residual/partial loss of income rider will add value.
To be disabled on a loss of income basis, there must be a causal link between the loss of earnings and the underlying illness or accident. No policy describes exactly how causality is determined, however there are differences in latitude for intervening factors. Comparing the wording between different policies is one of the ways Disability Underwriters adds value to the process.
Depending on the recovery provision, loss of income benefits may be payable even though the person is no longer disabled...a helpful feature when compensation is delayed. For example, professionals who maintain a book of business with long term clients are at risk of losing their client base and may never economically recover after returning to work. A similar "long tail problem" can happen to the extent a worker depends on bonus compensation due to the infrequency of payment, long sales cycle to earn bonuses, and murky determination formulas which the worker may have no direct control over. In short, a good loss of income rider can bridge the gap when medical recovery and economic recovery don't move in lockstep.
It is possible to have both riders (true own occupation and residual/partial loss of income) on the same policy so that the insured is in a position to take advantage of whichever definition is best at the time of claim. If one must choose between the two for budget reasons, residual/partial loss of income is the more important due to the flexibility of work choices.
When do disability benefits start?
Benefits begin after the Elimination Period is satisfied. The Elimination Period is the number of days after disability begins during which benefits do not accrue. A typical comprehensive income protection policy has an Elimination Period of ninety (90) days in order to keep the premium down and avoid overlap with other sources that are commonly available such as state disability benefits, employer-funded salary continuation, and short term disability insurance.
If short term sources are not available, the most common plan is to draw down assets. Shorter Elimination Periods (of 30 or 60 days) and standalone short term disability insurance policies are also available.
How long do disability benefits last?
Benefits cannot go past the Benefit Period chosen at application, which is typically to age 65, 67, or 70. Lifetime benefits may be available with some policies in special situations. As a worker approaches this age and continues to work beyond it, most policies renew with a rolling 2 year Benefit Period.
Absolute Benefit Periods like 2 years or 5 years are also available, which buys valuable time at a low cost. Many higher end policies use "per claim" Benefit Periods - as opposed to aggregate - meaning the policy can be used multiple times with a fresh Benefit Period.
Some policies have special limitations for psychological claims. This is also referred to as a "psych limit" or "mental/nervous limit", and is commonly defined by what is published in the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Psych limits are typically 24 months which may be either per claim or aggregate depending on the policy.
What is the benefit amount based on?
Individual disability insurance benefits are pre-determined at the time of policy acquisition by the "issue amount." This is a fixed dollar monthly indemnity amount - e.g, $5,000 per month, $10,000 per month, etc. In theory, the insurer would issue whatever amount the individual applies for. In practice, the individual always wants more than the insurer is willing to issue, therefore the issue amount ends up being the maximum amount the individually qualifies for at the time of application based on a snapshot of current earnings.
As future earnings fluctuate, the issue amount remains static unless the policy owner takes action to increase it. Over the course of a worker's career, the issue amount is often ratcheted up, but never down. The contractual guarantee to maintain the issue amount during a period of declining earnings is unique to individual disability insurance.
Is 100% Income Replacement Possible?
100% income replacement is possible in the following situations:
(1) A future decline in earnings can result in income replacement ratios exceeding 100%. Unlike group coverage, individual policies are often issued on a non-cancellable and guaranteed renewable basis, which prevents the insurer from making downward adjustments except at the policyowner's request. From the insurer's standpoint, the risk is that an individual will take advantage of these guarantees by acquiring coverage after a peak earnings year. Insurers cannot prevent this, but they can somewhat reduce the likelihood of it happening by qualifying applicants up front based on historical earnings stability and employment stability.
(2) The acquisition of group insurance after individual insurance is issued may result in greater than 100% income replacement, because group and individual coverages generally don't integrate with one another. When a person is in the process of acquiring coverage, group insurance does not ask about what other coverages a person has, whereas individual insurers do.
(3) If the policy is of the "true" own occupation sort (discussed above), it is possible to collect full benefits regardless of any earnings from a different occupation. The combined total can equal or exceed 100%.
(4) 100% may be possible right out of the gate by including certain riders, such as
group supplement riders
student loan riders
Replace 401(k) or other retirement contributions so that you keep saving during a period of disability.
For individuals contributing to a retirement plan.
Is bonus and equity compensation covered?
For purposes of qualifying for a new policy and determining the maximum possible issue amount, insurers will include bonus, commission, and equity compensation if it is included in W-2 earnings and is a regular part of a person's compensation.
If a person is not working at all due to disability, the type of pre-disability earnings is irrelevant because the benefit is the policy issue amount, with no calculation necessary. If a person is working but not earning as much as before (i.e. partially disabled), variable compensation is generally included in the calculation of pre-disability earnings, although treatment of equity compensation varies from policy to policy.
Can I increase coverage in the future?
Yes, if that option is built into the policy from the start with the appropriate rider(s), which might cost extra.
Medical underwriting is waived on future increases. This is the entire point, and because this adds to the carrier's risk, the application must be underwritten for future increases up front, with the applicable rider attached to the policy.
Carriers offer different types of increase options.
Automatic increase options require no action at all at the time of the increases - not even financial evidence. These "Automatic" increases offer maximum convenience, but the increases are modest (3% or 4%). The Automatic increase option itself is free, though the additional layers of coverage are not. Each year, the policyholder receives a reminder letter when the benefit and premium are about to increase. This letter includes opt-out instructions which, if acted upon, waives the increase and as a result the premium would remain unchanged.
Larger increases are available through other types of increase options which have different labels such as Future Increase Option, Future Purchase Option, Benefit Update or Benefit Increase Rider. Although medical underwriting is waived, it will still be necessary to financially qualify at the time of the increase. If a person does not financially qualify for an increase, previously issued coverage would remain unaffected. Certain variations of these riders are available for no additional cost, however they don't have the level of guarantees and control that the paid varieties offer.
Future increase options generally stop at age 55 or 60, depending on the policy rider.
Adding layers of coverage in the future is not free. There is a charge based on the added volume, which begins at the time the respective layers of coverage are added. The unit-cost rate for any given layer is based on the age when that layer is added and is independent of other layers. Due to increasing age, each layer has a higher unit cost than the one added before it. The favorable price of previously purchased layers are not affected by additions. Therefore, the premium for the policy as a whole is actually the sum of each layer of coverage added over the years. Of course if you never exercise an increase option, the premium for a non-cancellable policy would remain level.
If you expect your earnings to rise significantly in the future, plan ahead for future increases and be sure to apply for the appropriate rider. Again, there may be a cost for the rider itself.
What if I change occupations?
The test for disability would be relative to your new occupation. You don't need to update the carrier and the policy is just as valid as it was before. Insurers take the chance that you may change occupations after the policy is issued and there is nothing they can do about it.
If you file a claim while unemployed, the test for disability will depend on the policy. Some will base it on your career occupation using a common sense standard, others will use an any-occupation test.
What happens after Age 65?
Most policies change to "conditionally renewable" status at the policy anniversary after reaching age 65, but a few change status at age 67 or age 70. The changes may include:
1. Renewability is conditioned upon full time work.
2. Riders drop off the policy.
3. The Benefit Period is a rolling 2 years.
4. The premium goes up annually.
Renewability is no longer automatic and certain conditions must be satisfied on an annual basis in order for coverage to continue for another year. Fortunately, medically re-qualifying is not involved. Neither is occupational underwriting. The most important condition is that a person must continue to work full time. What defines full time is typically 30 plus hours per week which can be asserted with reasonable flexibility (e.g., in a "typical week") Some policies specify a certain number of months out of the year (e.g., 10 months). Self-employment counts, and it is quite common for pre-retirees to renew on the basis of 1099 work. Carriers don't nick-pick whether a person is actually working full time, but they would definitely contest full time status if your employer was registering you as part-time and you had no other work on the side.
Riders drop off the policy, leaving only the base policy. The implications of this are complex because riders can perform many functions. Regardless, the base policy remains the same amount as it has was prior to age 65 - with no benefit reduction - even if earnings decline.
The Benefit Period becomes a rolling 2 year Benefit Period, meaning that whenever claim starts the benefit would continue for two (2) years from that point. For example, if a claim starts at age 68 benefits may be payable to age 70 (not longer than 2 years). There are a few policies that reduce the Benefit Period based on age when the claim starts, but the standard is a rolling 2 years.
The premium goes up annually, which is different than the pre-65 years when the premium was level. Most people would consider the amounts charged quite reasonable considering the risk, and is justified for as long as the person continues to be dependent on earned income.