14.3.1 Presumptive Disability
The presumptive disability provision is found in most disability policies. Technically, partial disability does not qualify a person for benefits under a disability insurance contract, only total disability qualifies. However, the definition of total disability is sketchy at times.
If a person has one of the disabilities listed below, they are "presumed" to be totally disabled and are entitled to receive the full benefits under the policy regardless of whether he or she is able to work at any job.
- Blindness
- Deafness
- Loss of two or more limbs
For instance, Dee has been a writer for the firm for years and she suffers an accident which results in the loss of both legs. She can still perform her job but, because of the severity of her condition, it is "presumed" that she is totally disabled.
Presumptive disability entitles her to total disability benefits for the rest of the policy's benefit period.
(Presumptive disability benefits are often paid in a lump-sum settlement with the insured.)
