What is a Disability?
There are several definitions of "Disability" within a disability insurance policy, therefore there are several ways you can be disabled under the terms of the contract. To answer your question in a simple fashion, it is a sickness or injury which interferes in your ability to work and bring home an income. Many people think of "suffering a disability" as a car accident, but the reality is most are illness related. One lesson we have learned over the years is an illness does not care what you do for a living. In an actual policy, the most common definitions of Disability are; Total Disability, Residual Disability, and Presumptive Disability.
1. Totally Disabled
The definition of total disability in Provider Choice is a true own-occupation definition for all occupational classes, unless you choose the "modified own-occupation" option. Total disability or totally disabled means that, solely due to injury or sickness, you are not able to perform the material and substantial duties of your occupation, or occupations if more than one, in which you are engaged at the time of disability.
2. Residual Disability
Sometimes an illness or injury doesn't cause a total disability but does limit your ability to work, which results in decreased income. Or, you might suffer a total disability and return to work, but not at your pre-disability earnings. Our Residual Disability Benefit Rider1 provides benefits when, solely due to injury or sickness, you suffer a loss of income of 15% or more. Benefits are calculated using dollar-for-dollar income replacement for the first 12 months, up to the policy's monthly benefit.2 After that, benefits are paid in proportion to your income loss. If the loss of income is 75% or more, we will consider the loss to be 100%. For individuals who own their own business, are in sales, or are the chief rainmaker for their company, we highly recommend a Residual Disability Benefit Rider on your policy.
3. Presumptive Disability
Should you suffer the total and complete loss of hearing in both ears, speech, sight in both eyes, or the entire use of both hands, both feet, or one hand and one foot, the insurance company will pay you first day benefits. In other words, you do not need to wait through the elimination period before you become eligible for monthly benefits if you suffer one of those losses. Berkshire's Provider Choice will always consider you to be totally disabled even if you are gainfully employed, if injury or sickness results in a presumptive loss.
How Do I File A Disability Claim?
If you become sick or injured and are unable to work, you should immediately notify Claims Management Services at Berkshire. The earlier you notify Berkshire of your circumstances, the sooner they will be able to begin their evaluation of your eligibility for benefits. More importantly, your policy contains specific information regarding the time frame in which you must submit notice of claim. Contact Berkshire using any of three methods:
- Toll Free: 888-275-7473
- E-mail: email@example.com
- Mail: Claims Management Services, 700 South Street, Pittsfield, MA 01201
1. In California, this is called the Partial Disability Benefit Rider. Additional conditions and limitations apply.
2. If you own multiple disability insurance policies, the feature payable under the Residual Disability Benefit Rider will be reduced by benefits payable under those policies that were in force before this rider was issued, so that the sum of all disability benefits does not exceed the actual lost income.