Ten policy structures, fourteen occupation profiles, twelve state programs and the benefit arithmetic behind each — so you can see what actually pays before you sign.
Own-occupation, any-occupation, group and hybrid — definitions compared.
Return-of-Premium Term explained: any-occupation definition, 5–10 years benefits, 90 days elimination period, $45–$95/month. Who it fits and the clauses that matter.
Critical Illness Rider Bundle explained: n/a — lump sum on diagnosis definition, Lump sum benefits, Survival period elimination period, $30–$80/month. Who it fits and the clauses that matter.
Disability Buy-Out explained: own-occupation definition, Lump sum benefits, 90–180 days elimination period, $80–$180/month. Who it fits and the clauses that matter.
Key Person Disability explained: own-occupation definition, 1–5 years benefits, 90 days elimination period, $60–$150/month. Who it fits and the clauses that matter.
The arithmetic behind the monthly check, line by line.
Cost of living (COLA) riders: How the Monthly Number Is Actually Calculated
Cost of living (COLA) riders: basis = n/a, ratio 3% simple or cpi-u, taxed same.
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Residual (partial) disability benefits: How the Monthly Number Is Actually Calculated
Residual (partial) disability benefits: basis = pre-disability vs current earnings, ratio 50% of loss, taxed follows primary claim.
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Own-occupation vs any-occupation payment: How the Monthly Number Is Actually Calculated
Own-occupation vs any-occupation payment: basis = n/a, ratio own-occ pays more, longer, taxed same taxation.
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Bonus and commission income: How the Monthly Number Is Actually Calculated
Bonus and commission income: basis = documented 2-year average, ratio often excluded or capped, taxed varies.
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What evidence wins, condition by condition.
Pregnancy / maternity leave claims: evidence needed — ob records + delivery date. Typical outcome: short benefit (6–8 weeks) typical.
Long COVID / post-viral fatigue claims: evidence needed — excluded conditions ruling + pulmonary/cognitive testing. Typical outcome: highly contested.
Mental health conditions claims: evidence needed — psychiatry history + medication trials + hospitalization records. Typical outcome: capped at 24 months on most policies.
Heart attack / cardiac event claims: evidence needed — cardiology records + ejection fraction + stress test. Typical outcome: approved short-term; long-term contested.
Every stage from first call to appeal, with deadlines.
Appeal after denial: deadline — 180 days from denial (erisa group plans). Key move: lawyer before the appeal, not after.
Surveillance reality: deadline — any time during claim. Key move: assume every public outing is recorded.
Independent medical examination: deadline — carrier-scheduled. Key move: attend, answer only what is asked.
Ongoing proof of loss: deadline — monthly or quarterly. Key move: calendar the deadlines yourself.
What group coverage really pays — and the portable fix.
Small business owner self-funded: What It Pays, What It Misses and the Portable Fix
Small business owner self-funded: replaces whatever is set aside, definition = n/a, portable = n/a.
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Executive carve-out individual policy: What It Pays, What It Misses and the Portable Fix
Executive carve-out individual policy: replaces individual layer on top, definition = own-occupation, portable = yes.
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Voluntary employee-paid group: What It Pays, What It Misses and the Portable Fix
Voluntary employee-paid group: replaces 40–60% of base, definition = any-occupation typically, portable = no.
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Offsets, waiting periods and taxation compared.
Work incentives: SSDI — trial work periods; private — per residual provision.
Taxation of benefits: SSDI — taxable above income thresholds; private — tax-free if you paid premiums.
Offset provisions: SSDI — full benefit regardless; private — reduced by ssdi received.
Premium classes by job and what they mean.
Construction manager disability cover: class 3, $100–$180/month, own-occupation modified. Underwriting notes and what to ask for.
Physical therapist disability cover: class 4, $65–$120/month, own-occupation yes. Underwriting notes and what to ask for.
Chef disability cover: class 3, $90–$165/month, own-occupation often modified. Underwriting notes and what to ask for.
Long-form explainers, cost breakdowns and field notes — updated as rates and rules change.
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