I recently spoke with a claimant regarding a letter he received from Ohio National that indicated he was not eligible to receive lifetime disability benefits as he was not totally disabled before the age of 60 and continuously so through the age of 65. During our initial call I advised him that although each disability carrier and/or policy can differ in language, as a general rule it is very common that lifetime benefit provisions in individual disability policies require an insured to be totally disabled (not partially/residually disabled) prior to a certain age in order to qualify for a lifetime benefit. As he had continued to work, albeit in a greatly reduced capacity after the age of 60, it would seem his claim would fall into this scenario. Regardless, I wanted to review the letter he received as from experience I know that things are not as clear cut as Ohio National would have him believe.
Prior to our follow up free consultation the claimant sent me copies of two disability polices he had with Ohio National. Upon review of one of the policies it was clear that his benefit under same would in fact end at age 65. However, his other policy contained a unique definition of total disability that led me to believe he may have a way to collect lifetime benefits:
Total Disability or Totally Disabled: You are Totally Disabled or have a Total Disability if (a) you are not able to do the substantial and material tasks of your own job due to Injury or Sickness; and (b) you are under a Physician’s Care. . . You are not Totally Disabled if you are working at your own job and are earning more than 25% of your Monthly Earnings Before Disability. [Emphasis added]
It is this last sentence that raises the potential for a strong argument that despite his working past the age of 60 he could qualify for Lifetime Benefits. Whereas Ohio National was evaluating his claim as a Partial Disability claim due to the fact he was working, from the above definition it was my opinion that if his earnings were less than 25% he would be deemed Totally Disabled- a qualifier for receiving lifetime benefits under the policy.
Traditionally, if you are working in your occupation but are suffering a loss of income- typically a 20% loss- your claim would be considered a Residual or Partial Disability claim. The claimant’s policy did have a Partial Disability provision, which as noted above Ohio National had been issuing his monthly benefits under. Normally, if you are being paid under a Partial/Residual disability and suffer a 75% loss of earnings the carrier will issue 100% of your monthly benefit, and in doing so the insurance company will still categorize you as Partially Disabled and not Totally Disabled under the policy provisions. This distinction is very important as Lifetime Benefit Riders do not typically allow for, or contemplate, Partial Disability- you must be Totally Disabled in order to qualify.
The letter the claimant received did not even mention the above definition of Total Disability, and was frankly a lazily written letter to explain to an insured why his claim was being closed. In speaking with the claimant and reviewing information sent I advised him that if he could show that his earnings were less than 25% of his pre-disability earnings from the age of 60 through 65 then there would be an argument that Ohio National was misapplying the appropriate definition/standard of disability and had miscategorized his claim for benefits, which could result in hundreds of thousands owed over the course of his lifetime.
Are you eligible for Lifetime benefits with Ohio National?
If your policy contains the same definition of disability and you have worked and earned less than 25% of your pre-disability earnings before the age of 60 through the age of 65 you could be entitled to lifetime benefits. Based on the above referenced policy provisions it could be possible that Ohio National has miscategorized your claim as a Partial Disability claim and in doing so deprived you of a lifetime benefit. As was the case with the gentleman I spoke to, each claim would require a detailed investigation on its specific merits to determine the applicability of the lifetime benefit. Time will tell for him if the financial information will support the required loss of earnings over the five year period to make a strong argument to Ohio National as to his entitlement to lifetime benefits.
If you have questions regarding your claim with Ohio National or want to know if this plan provision can be used to maximize your earning potential while on disability and still qualify for a lifetime benefit please contact our office and ask to speak to Attorney Jessup or one of our other disability attorneys.
We have a detailed page about Ohio National claims where you can read more about this topic.