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Criteria to Qualify for Disability Insurance

Having a disability can be a life-changing experience. According to data, 42.5 million Americans are living with a disability that’s affecting their quality of life in one form or another.

Disability can be natural or caused by an accident, work-related incident, or health issues. If you had a job and were capable of fully providing for your family before a disability, getting the disability can significantly affect your income, independence, and quality of life.

Disability insurance deals with this challenge. To qualify for disability insurance or Social Security Disability Insurance (SSDI) benefits, you must have a medical condition meeting the definition of a disability and have worked jobs covered by the policy.

Here’s all you need to know about disability insurance and how to check for legibility.

What is Disability Insurance?

Disability insurance is an insurance cover that provides income to the policyholder when they’re prevented from working due to a disability.

The U.S. government provides disability insurance through the Social Security System. However, you can also purchase disability insurance policies from private insurers.

What is Defined as a Disability?

The benefits and legitimacy of a disability insurance claim depend on the definition of a disability used by the insurer. Different disability insurance policies, therefore, offer unique definitions of a disability to qualify for the benefits.

For instance, under the Social Security System, disability is defined as total disability, meaning your capacity to do work has been entirely affected. Therefore, the SSDI offers no benefits for partial or short-term disability.

Under SSDI, you have a qualifying disability if:

  • Your medical condition doesn’t allow you to work at your previous job or adjust to other work

  • Your medical condition doesn’t allow you to work at the substantial gainful activity (SGA) level

  • Your medical condition has lasted or is expected to last over a year or result in death

With other policies, there may be specific levels of disability defined with unique compensation for each level of definition.

What are the Different Types of Disability Insurance?

There are two primary types of disability insurance. These are short-term disability insurance and long-term disability insurance.

Short-term disability insurance has a wait period of 0 to 14 days before it kicks in. It offers a maximum benefit period of two years.

Long-term disability insurance has a waiting period of several weeks or months before the benefits kick in. Once they do, you’re eligible for them for a couple of years or the rest of your life, depending on the policy.

Regardless of your policy, most disability insurance covers are non-cancelable and guaranteed renewable. This means that the insurer cannot cancel the policy unless you’ve not paid your premiums. Therefore, you retain the right to renew your policy annually without increasing premiums or reducing benefits.

Also, by being guaranteed renewable, your insurer can raise the premiums for your cover if it cuts across all other policyholders in the same rating class as you.

How Does One Qualify for Disability Insurance?

Different insurers typically use different qualifiers for claiming disability insurance benefits. For the SSDI, the conditions are that you’ve worked in a job covered by social security, and your medical condition meets their strict definition of a disability.

For work, you must have worked long enough and recently enough to qualify for the benefits. Social Security work credits depend on your total yearly wages or income from self-employment. Typically, you can earn up to 4 credits annually.

The SSDI implements changing requirements for acquiring a work credit every year. For instance, in 2024, $1730 in wages or self-employment income earns you one work credit. Therefore, $6,920 earns you four work credits for the year.

The amount of work credits you need to qualify for disability benefits will depend on the age at which your disability begins.

Typically, you need 40 credits, 20 of which you earned in the last ten years before your disability. Younger workers can qualify for disability benefits with lower work credits.

How You’re Checked if You Have a Disability

Each insurer will use a unique process to check if you have a qualifying disability for benefits from your coverage. Typically, they’ll check for the following:

Are You Working?

Based on your earnings, the insurer will determine whether your disability qualifies for benefits. For instance, for SSDI, earnings above $1550 on average, or $2590 for blind people, don’t qualify you for the benefits.

Is Your Condition a Covered Condition?

Disability insurance will only cover select “disabling conditions.” Therefore, the insurer must first assess whether the medical condition is on their covered list for your policy.

How Severe is Your Condition?

The insurer will examine your medical condition to determine its severity. Therefore, depending on your policy, you may be eligible for benefits.

The test will typically check whether the medical condition prevents you from doing basic work-related activities such as standing, lifting, sitting, walking, or remembering.

Can You Do Your Previous Job?

In most cases, the disabling medical condition must be severe enough to prevent you from doing your previous job.

Can You Take Any Other Type of Work?

Depending on the policy, you must also show that you can’t take on any other type of work apart from your previous job to qualify for disability insurance.

Options You Can Consider When Buying a Disability Insurance Policy

There are several options you should consider when purchasing a disability insurance policy. These include additional purchase options, coordination of benefits, cost of living adjustment, residual or partial disability rider, return or premium, and waiver of premium provision.

Your insurance company should give you the right to purchase additional insurance later. Moreover, your policy should have the benefits cover for the difference not paid by other policies.

This means that the benefits disbursed for your policy will depend on other benefits you receive because of your disability, based on a target amount specified for all the policies combined.

Your disability benefits should also have a cost of living adjustment (COLA) to ensure they increase over time as the cost of living rises. However, adding COLA to your policy will often result in higher premiums.

With a residual or partial disability rider, you can return to work part-time, collect part of your salary, or receive a partial disability payment.

If no claims are made for a specified period, you can use the return on premium option to ensure the insurer refunds part of your premiums for the policy.

Since disability will affect your work and livelihood, the waiver of premium provision option ensures you get a waiver on premium payments for your policy 90 days after you’re disabled.

Have an Expert Guide You

Getting disability insurance is a smart choice if you want to prevent a total loss of income in case a medical condition makes you unable to do work. Talk to an insurance expert and learn the options you have for your business or profession.


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