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Showing posts from August, 2023

Vocational Expert Opinions

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Vocational Expert Opinions Also called “jobs experts” or “VEs”, vocational experts have specific training in Vocational Rehabilitation or Vocational Counseling. The VE forms an expert opinion on what jobs a claimant may be able to perform. Vocational expert opinions are often used in long-term disability claims. When a person files a long-term disability claim, the insurance company will often ask them to undergo a vocational assessment. This assessment will be conducted by a vocational expert who will determine the person's ability to perform the material duties of their occupation. If the vocational expert determines that the person is unable to perform the material duties of their occupation, then the insurance company may be required to pay benefits. The VE may come to the conclusion that there are no jobs available. Their expert opinion takes into account the claimant’s RFC, all restrictions and limitations caused by the impairment, and their age, education, background,

Self-reported Symptoms Limitation

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Self-reported Symptoms Limitation A self-reported condition is defined as a disability that has been diagnosed based on symptoms like pain and fatigue that a patient has reported but a doctor cannot verify using tests. Disabling conditions that are often considered self-reported include fibromyalgia, chronic fatigue, tinnitus, lupus, headaches, arthritis and Lyme disease. The purpose of a self-reported symptoms limitation is to protect insurance companies from fraudulent claims. These conditions can be difficult to diagnose, and there is no way to objectively measure the severity of the symptoms. As a result, some people may try to claim disability benefits for these conditions even though they are not actually disabled. Unfortunately, some symptoms are self-reported by the claimant that are not easily validated by objective testing. Some policies have a provision limiting coverage (often two years) for disability benefits due to an illness or injury that is based on self-reporte

Benefits Payable Exclusion

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Benefits Payable Exclusion A benefits payable exclusion is a clause in insurance policy contracts that removes the insurer's responsibility for paying claims related to employee benefits. Specifically, the clause protects the insurer from paying for benefits that could otherwise be paid from an alternative source, such as the employer's pension plan, health insurance plan, or other benefits plan. A benefits payable exclusion is a legal clause indemnifying an insurer against claims relating to employee benefits. These types of claims are regarded as an uninsurable business risk. In practice, courts will sometimes require insurers to cover such claims even if a benefits payable exclusion clause is in place. There are a few exceptions to the benefits payable exclusion. For example, the insurer may be responsible for paying claims if the plan is insolvent or if the funds in the plan are not available to pay the benefits. Additionally, the exclusion may not apply to claims tha

Punitive Damages (exemplary damages)

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Punitive Damages (exemplary damages) punitive damages are payments awarded by a judge or jury to punish bad actors engaging in reckless, willful, malicious or wanton conduct, and to deter similar wrongful conduct in the future. Punitive damages are not awarded in all cases. They are typically only awarded in cases where the defendant's conduct is found to be especially egregious, such as in cases of fraud, intentional infliction of emotional distress, or reckless disregard for the rights of others. The amount of punitive damages that can be awarded is typically capped by law. The cap is designed to prevent punitive damages from becoming excessive and to ensure that they are proportionate to the defendant's conduct. Examples of this would be drunk driving or distracted driving for an individual case. For corporate an employer is said to be vicariously liable for the acts or omissions of an employee when the employee engages in wrongful conduct while within the scope of em

Riders

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Riders It is an insurance policy provision that adds benefits to or amends the terms of a basic insurance policy. Riders provide insured parties with additional coverage options, or they may even restrict or limit coverage. There is an additional cost if a party decides to purchase a rider. The cost of a rider will vary depending on the type of rider and the insurance company. It is important to carefully read the terms and conditions of any rider before you purchase it. Riders come in various forms, including long-term care, term conversion, waiver of premiums, and exclusionary riders. In some cases, a policyholder may not be able to add a rider after the policy has been initiated. Overall, riders can be a valuable way to customize your insurance coverage and protect your financial interests. However, it is important to carefully consider your needs and options before you purchase a rider. If you are considering adding a rider to your insurance policy, it is important to talk

Maximum Benefit Period (Benefit Duration)

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Maximum Benefit Period (Benefit Duration) The maximum benefit period (MBP) is the maximum amount of time that you can receive disability benefits under your policy. It is usually expressed in years. The MBP is one of the most important provisions in your disability insurance policy, as it determines how long you will be financially protected if you become disabled. Maximum Benefit Period means that maximum amount of time, during which benefits will be paid under the Plan for your Non-Occupational Disability or Occupational Disability following the Elimination Period for the coverage you elected under the insurance Plan. Your Maximum Benefit Period is determined by your age when you become Disabled. In some jurisdictions, If you become Disabled prior to retirement, the Maximum Benefit Period ends at age 65. The MBP can also be affected by your age when you purchase the policy. For example, a policy purchased at age 60 may have a shorter MBP than a policy purchased at age 30. Accid

Commencement Date/Effective Date

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Commencement Date The commencement date in insurance is the date on which the insurance coverage takes effect. It is also known as the effective date or policy start date. The commencement date is usually specified in the insurance policy. For most types of insurance, the commencement date is the date on which the premium is paid. However, there are some exceptions. For example, in life insurance, the commencement date is typically the date on which the application is approved, even if the premium is not paid until later. The commencement date is important because it determines when the insurance coverage begins. For example, if you purchase a health insurance policy on January 1st, but the commencement date is February 1st, you will not be covered for any medical expenses that you incur between January 1st and February 1st. The commencement date is also important for calculating the surrender charges. Surrender charges are fees that you may have to pay if you cancel your insuranc

Lapse

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Lapse An insurance lapse is the period where you didn't have insurance because your policy ended and you didn't have new coverage to replace it. This can happen for reasons including: You miss a premium payment. The premium payment was not received by the due date. You do not renew the policy. Insurance rates are generally higher for policyholders with lapsed coverage. ways you can prevent a coverage lapse include: -Shop for the most affordable policy for the coverages you want. -Talk to your insurer if you’re having difficulty meeting your payments. -Know when it’s time to renew, or set up automatic renewals. -Make sure there’s no gap between the start and end dates of policies when you switch insurances. It should be noted that most policies can be reinstated within the policy's grace period. If your insurance lapses, you will no longer be covered for any claims that occur during that time. This could mean that you are responsible for paying for any damages or los

Beneficiary

Beneficiary A beneficiary in insurance is the person or entity that is designated to receive the benefits of an insurance policy. In life insurance, the beneficiary is typically the person or persons who will receive the death benefit when the insured person dies. In health insurance, the beneficiary is typically the person who is covered by the policy. Here are some examples of beneficiaries: Spouse, children, parents, Siblings, business partne, Key employee, trust, Charitable organization. If you do not name a beneficiary for your insurance policy, the benefits will typically be paid to your estate. This means that the benefits will be subject to probate and may be used to pay off your debts. When choosing a beneficiary, it is important to consider the following factors: -The relationship between the beneficiary and the insured person. -The beneficiary's financial needs. -The beneficiary's age and health. -The beneficiary's ability to manage the benefits. For examp

Group Life Insurance

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Group Life Insurance Group life insurance is a type of life insurance that is purchased by an employer or other organization and provides coverage to a group of people, such as employees, members, or students. The premiums for group life insurance are typically paid by the employer or organization, and the benefits are paid to the beneficiaries of the insured person if they die while covered by the policy. In other cases for example associations the members contribute towards a fund that pays the premium as a group on their behalf. Group Life Insurance assures employees that in the unlikely event of death, disability or critical illness, a multiple of their annual salary will be provided to their beneficiaries as a replacement income. In a Group life insurance policy a single contract covers an entire group of people. Typically, the policy owner is an employer or an entity such as a labor organization, and the policy covers the employees or members of the group. These are the mos

Life Insurance Trust

Life Insurance Trust A life insurance trust is a legal arrangement that places ownership of a life insurance policy in a trust. This can be done during the insured person's lifetime (revocable life insurance trust) or after their death (irrevocable life insurance trust). The trust is managed by a trustee, who is responsible for paying the premiums on the policy and distributing the death benefit to the beneficiaries when the insured person dies A life insurance trust is an irrevocable, non-amendable trust which is both the owner and beneficiary of one or more life insurance policies. Upon the death of the insured, the trustee invests the insurance proceeds and administers the trust for one or more beneficiaries. Revocable life insurance trust (RLIT). An RLIT is a trust that can be changed or revoked by the grantor at any time. This means that the grantor retains control of the trust and the life insurance policy. RLITs are not as effective as irrevocable life insurance trusts (

Permanent Life Insurance

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Permanent Life Insurance Permanent life insurance is a type of life insurance that provides lifelong coverage and the opportunity to build cash value. The cash value accumulates on a tax-deferred basis, which means you don't have to pay taxes on the interest or dividends that it earns. You can access the cash value while you're still alive by taking a loan against it or by withdrawing it. The two primary types of permanent life insurance are whole life and universal life; Whole life insurance: Whole life insurance is the most basic type of permanent life insurance. It provides guaranteed lifelong coverage and a guaranteed cash value. However, the premiums for whole life insurance are typically higher than for other types of life insurance. Universal life insurance: Universal life insurance is a more flexible type of permanent life insurance. The premiums and death benefit can be adjusted up or down, and the cash value can be accessed more easily than in a whole life poli

Cost of Living Rider

Cost of Living Rider A cost of living rider is an add-on feature to an annuity contract that adjusts the amount of your annuity payments annually to help them keep up with increases in the cost of living. Other names for cost of living riders include cost of living adjustment riders and COLA riders. COLA riders are typically available for life insurance policies, annuities, and long-term care insurance policies. They can also be added to some retirement plans. For example a cost of living rider increases the disability benefit each year according to a percentage derived from the Consumer Price Index measure. What the cost of living rider gives the insured is that it adjusts the amount of monthly disability benefit received by the insured each year during his or her disability. The first adjustment is on the 13th month of disability. The adjustment that is made in the monthly benefit depends upon the way the rider is designed. The cost of a COLA rider will vary depending on the typ

Concurrent Disability

Concurrent Disability A concurrent disability occurs when there is more than one injury or illness. Though there is more than one factor causing disability, the concurrent disability benefits are paid as if there is only one injury or illness. The insured will be considered to have one disability. The disable individual may be eligible to receive disability benefits from two or more sources at the same time. This can happen in a few different ways: An individual may be eligible for both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). An individual may be eligible for disability benefits from their employer's group disability insurance plan and from Social Security Disability Insurance (SSDI). An individual may be eligible for disability benefits from two or more different individual disability insurance policies. When an individual is eligible for concurrent disability benefits, the amount of benefits they receive will be reduced to p

Cash or Accrual Method

Cash or Accrual Method The cash method and accrual method are both acceptable accounting methods for insurance companies. However, the accrual method is generally considered to be the better method for insurance companies because it provides a more accurate picture of their financial performance Accrual accounting means revenue and expenses are recognized and recorded when they occur, while cash basis accounting means these line items aren't documented until cash exchanges hands. Cash basis accounting is easier, but accrual accounting portrays a more accurate portrait of a company's health by including accounts payable and accounts receivable. The cash method may be used by small insurance companies with simple financial transactions. However, most insurance companies will need to use the accrual method to get a more accurate picture of their financial performance. The reasons why the accrual method is preferred for insurance companies: revenue recognition, expense recog

Business Overhead Expense

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Business Overhead Expense Business Overhead Expense (BOE) insurance is a type of disability insurance that pays for the fixed expenses of a business if the owner becomes disabled and unable to work. This can include rent, utilities, salaries, and other costs that are necessary to keep the business running. BOE insurance is designed for small businesses that rely on the owner's labor to generate revenue. This coverage helps owners keep their businesses running when they are too sick or hurt to work; 1) Running Your Business: Pay salaries to retain valuable employees and keep your business running. 2) Cover Fixed Expenses: Cover ongoing fixed expenses such as rent, property taxes and utilities. Business overhead insurance will not cover everything, including your own salary, so you will need to get an individual disability to protect your income. BOE insurance can be a valuable tool for small business owners to protect their businesses in case of an unforeseen disability. #be

Disability Buyout Policy

Disability Buyout Policy A disability buyout policy is a type of insurance that provides funds to purchase the interest of a disabled business owner or partner. This type of policy is typically used in conjunction with a buy-sell agreement, which is a contract between business owners that outlines the terms of how the business will be sold if one of the owners becomes disabled These buy-out disability policies usually require the claimant to be totally disabled for at least 12 months. A disability buyout policy pays installments to the insured’s corporation or business partner to buy out the business interest of the disabled owner. The agreement can be advantageous for both the business entity and the injured or ill person. For a business, disability buy-out insurance may guard against financial loss or even bankruptcy, ensuring the continuity of operations and employment for those on staff Owners also can be assured control of their business decisions, with the freedom to replac

Guarantee of Insurability

Guarantee of Insurability A policy option that allows the insured to increase the monthly benefit at specified dates. This feature is mostly found in life and health insurance that guarantees the insured the right to purchase additional insurance without undergoing a medical examination or otherwise providing evidence of good health. There are two main types of GI riders: Guaranteed purchase option (GPO) riders: These riders allow the policyholder to purchase a specified amount of additional coverage at specific dates in the future. For example, a policyholder might choose a GPO rider that allows them to purchase an additional $100,000 of coverage every five years. Guaranteed purchase option (GPO) riders: These riders allow the policyholder to purchase a specified amount of additional coverage at specific dates in the future. For example, a policyholder might choose a GPO rider that allows them to purchase an additional $100,000 of coverage every five years The benefit to the in

Conditional Receipt

Conditional Receipt A conditional receipt is a document issued by an insurance company to an applicant for insurance after the applicant has submitted an application and paid the first premium. The conditional receipt does not legally bind the insurance company to cover the applicant, but it does provide some coverage during the time that the application is being processed. If a policy owner pays a premium at the time of insurance application, she will receive a conditional receipt. With this receipt, the insured receives interim coverage during the underwriting process. This is subject to the terms and conditions of the receipt. This receipt means that the person can only be insured if he or she meets the standards of insurability and is given approval by the insurance company. The conditional receipt is typically valid for a period of 30 to 60 days. During this time, the insurance company will review and make necessary investigations, financial information, and other factors to

Continuous Disability

Continuous Disability In insurance, continuous disability refers to a disability that lasts for a continuous period of at least 12 months. This is a key definition in long-term disability insurance, as most policies require that a disability last for at least 12 months before benefits will be paid. There are a few different ways that continuous disability can be defined in insurance policies; Some policies may define it as the inability to perform the material duties of your own occupation for a continuous period of at least 12 months. Others may define it as the inability to engage in any substantial gainful activity for a continuous period of at least 12 months. Usually a periodically reviews is made to determine your medical impairment(s) to determine if you continue to have a disabling condition. If it is determine that you are no longer disabled, your benefits will stop. At this point you will be required to have a continuing disability review (CDR). Here are some of the fact

Level Guaranteed Issue

Level Guaranteed Issue Level guaranteed issue is a type of life insurance policy that does not require any medical underwriting. This means that you can be approved for coverage regardless of your health status, age, or gender. However, level guaranteed issue policies typically have higher premiums than policies that are underwritten. Guaranteed issue life insurance does not pay death benefits during the first two or three years the policy is in force, but it does return the policy’s premiums plus 10% interest if the insured dies during this period. Guaranteed issue policies are designed for people with serious health conditions that keep them from buying policies that offer immediate death benefits. Compared with other types of life insurance, guaranteed policies generally have high premiums relative to their death benefits because their policyholders are in poor health. However, there are also some drawbacks to level guaranteed issue policies. First, as mentioned, the premiums

Renewable Term Insurance

Renewable Term Insurance Also known as annual renewable term (ART). Insurance that is renewable for a limited number of successive terms by the policyholder and is not contingent upon medical examination. A renewable term is contingent on premium payments being up to date, as well as a renewal premium being paid by the beneficiary. With renewable term, coverage can be extended even if the insured's health has declined, but the new premiums will reflect their older age. Renewable term life will often have some limit at which point renewal is no longer an option, such as until age 70. major advantage of renewable term life insurance is that it allows you to reclaim your coverage at the end of your initial term. Allows you to keep the original face value amount (or death benefit) of your first policy. Permits you to renew your term life policy without having to start the application process again. #benewinsurance #insurtech #inclusiveinsurance #insurance #reinsurance #takaful