Example

John's Story

John is unemployed. In January 2010, he goes to the doctor because his back is hurting. The doctor prescribes some painkillers and sends him home to rest. In February, John gets a job and signs up for Long-Term Disability Insurance (LTD).

A month later, he gets a letter from the insurance company about his LTD. It explains that he will have a 2-month service wait. This means that he will have LTD coverage starting April 1, 2010, two months after the date he was hired. So, if John is injured between February and April, he will not be able to apply for LTD benefits. The LTD policy is an “Own Occ” policy, which means that John has to be unable to work in his own occupation, that is, the work John was trained to do and has experience in, to be defined as disabled in order to get benefits.

The letter goes on to explain that his back injury is a pre-existing condition, and that he will have a 1-year exclusionary period. The exclusionary period begins on the same day of his coverage, April 1, 2010. If he becomes disabled due to his back injury between April 1, 2010, and April 1, 2011, he will not be able to collect LTD benefits.

In May 2011, John hurts his back and can no longer go to work. Since the waiting period and exclusionary period are over, John can begin to get LTD benefits. He knows that it may take a while to get his first LTD check, so he immediately contacts his Human Resources manager. The manager tells him that there’s a 60-day waiting period from the date of disability before his benefits begin. John will start getting his benefits on July 1, 2011.

John was making $2,000 a month before he hurt his back again. His policy pays 50% of pre-disability wages for up to five years, so John will get $1,000 a month from LTD until he is no longer considered disabled or 5 years have passed, whichever is shorter.