Disability

This is a brief summary of the disability coverage provided under policy form WP DI 001 1223. See Policy for complete details.  Some states vary.
WHAT’S COVERED?

 

The Policy covers Disability, which means:

  • Inability due to Injury or Sickness to perform the material and substantial duties of the Insured’s occupation at the time the Disability starts, and;
  • Receiving continuous care by a licensed Physician, and;
  • Not working for wages or profit.
  • Disability includes Complications of Pregnancy but not pregnancy or childbirth absent such complications.

As shown on the Schedule Page of the Policy:

  • The Monthly Insurance Benefit Amount (chosen by the Insured at the time of application) cannot exceed the lesser of the Maximum Benefit Amount or 60% of an employee’s Monthly Salary or an Independent Contractor’s or Self-Employed individual’s Average Monthly Income at the time of application;
  • Benefits may be payable monthly for up to the Maximum Benefit Period;
  • A Waiting Period (retroactive or non-retroactive to the date disability begins) may apply before benefits begin;
  • A Lifetime Aggregate Maximum Benefit
WHAT’S NOT COVERED?

 

  The Policy excludes benefits for any Disability that is:

  • a result of a pre-existing medical condition which means that the Insured has been treated by, diagnosed by or consulted with a licensed Physician or licensed chiropractor for the medical condition in the Pre-Existing Conditions Months, as shown on the Schedule Page, before the Policy Effective Date and such condition becomes the cause of Disability within the Pre-Existing Conditions Months, as shown on the Schedule Page, after the Policy Effective Date;
  • due to hospitalization that occurs during the first ninety (90) days after the Policy Effective Date due to illness;
  • a result of normal pregnancy that does not include Complications of Pregnancy;
  • a result of war or any act of war (declared or undeclared);
  • a result of a self-inflicted injury;
  • a result of voluntary ingestion of illegal drugs;
  • a result of intoxication;
  • a result of injuries during commission of a felony;
  • a result of participation in a riot or insurrection; or
  • a result of an illegal occupation or activity.

Medical Care Requirement: Benefits are not payable for any period of Disability during which the Insured is not under the care of a licensed Physician. Such care must be appropriate, according to generally accepted medical standards for the condition which is causing the Disability and must be provided by a licensed Physician whose area of expertise is appropriate for the Sickness or Injury.                  

If the Insured incurs a qualifying Disability event and a qualifying Involuntary Unemployment event or Salary Gap event simultaneously, only one benefit will be paid, and it will be the larger of the two benefits amounts.

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