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Since my policy contains a Waiver of Premium While Disabled Provision, should I still pay the premium for my long-term disability insurance policy while my long-term disability claim is under review?


  • Unum Disability Company Forced to Extend Disability Insurance Coverage to Doctor

Attorney Cesar GavidiaAuthor: Attorney Cesar Gavidia

Many individual and group disability insurance policies contain Waiver of Premium provisions that allow for the waiver of the annual premiums while you are disabled. However, if your claim is pending and under review, you should continue to make all premium payments which become due until the long-term disability insurance carrier informs you that your claim has been approved and you no longer need to continue making premium payments. Once your disability claim has been approved, the disability carrier will reimburse you the amount of any premiums paid after your date of disability.

If you fail to make the premium payment and the disability carrier determines that you are not disabled then your policy will lapse, and the disability carrier will likely refuse to once again insure you since you are now a high a risk individual due to your reported medical condition, despite the fact that the disability carrier does not find you to be disabled. Insurance companies seek to insure low risk individuals that are unlikely to file disability claims, as opposed to high risk individuals with existing medical conditions. You may still pursue your existing disability claim; however, you will need for the insurance company or a court of law to overturn the denial of benefits in order for the disability policy to once again become effective.

There are 2 opinions so far. Add your comment below.

Katherine:

I became permanently and totally disabled 7 years ago. I had a short term disability policy, a life insurance policy and a disability waiver of premium policy for the STD and Life insurance policies. I exhausted my STD benefits. I was then approved for SSD benefits with a 5-7 yr review period. I have continued to receive the disability waiver of premium for my life insurance, which I must recertify each year. This past year, a new plan administrator took over & they want a bunch of info. I am uncomfortable providing. They initially sent me the usual two forms, one for and one for my doctor. These were completed and returned recertifying my continued TPD.

Now, the company is demanding I sign a release of information form for ALL my medical records, to conduct an investigative background check and to release all my SSN records. They also indicate they will provide information received to the MIB. This just seems like overkill. Do I have to provide this info and is there any way to limit dissemination of my confidential medical information?

Attorney Jay Symonds:

Katherine, carriers are generally allowed to conduct a reasonable investigation to determine whether you continue to satisfy the Policy requirements for disability. There can be limits to the extent of the investigation if the information or documentation being sought is not relevant or is unreasonable and there are ways to limit the dissemination of confidential information. I suggest you contact our office and speak with one of the attorneys to address any questions you have regarding your specific situation.

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