What is presumptive disability insurance?

Presumptive disability insurance pays full disability insurance benefits if you receive a disability so severe that total disability can be presumed.

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Zack SigelManaging EditorZack Sigel is a former managing editor at Policygenius who oversaw our mortgages, taxes, loans, banking, and investing verticals.

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Disability insurance will pay out benefits for any qualifying injury or illness that prevents you from earning an income according to your policy’s definition of disability. This is called total disability coverage. However, most long-term disability insurance policies include a provision for presumptive disability, which pays out your full insurance benefits, potentially for life, if you receive a disability so severe that total disability can be presumed.

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Presumptive disability definition

When insurance companies refer to presumptive disabilities, they're usually referring to:

  • Loss of speech

  • Loss of hearing

  • Loss of sight in both eyes

  • Loss of at least two limbs

→ Learn more about what disability insurance covers

How to get presumptive disability insurance

Presumptive disability coverage is included in most disability insurance policies. If your policy doesn’t have presumptive disability coverage, then it may be necessary to ask your insurer to add the provision in the form of a disability rider.

If you're shopping for a long-term policy, a licensed agent at Policygenius can get you disability quotes and coverage that meets your needs.

Presumptive disability vs. total disability

Your disability insurance coverage is first and foremost for total disability, which means you’re so disabled that you can’t work for some length of time. The presumptive disability provision means that you have virtually no chance at making a full recovery. However, there are some key differences between total disability and presumptive total disability.

Presumptive disability benefits have no elimination period

The elimination period, also called the waiting period, is a length of time after you become disabled that must pass before you’re eligible to receive your first benefit payment. The most common elimination period is 90 days, but you can get shorter elimination periods if you’re willing to pay higher premiums.

Presumptive disability has no waiting period. Since you’re expected to be disabled for life, you can start receiving benefit payments from the moment you become disabled (after filing a claim, of course).

Presumptive disability benefits last your entire life

The benefit period is the number of months or years during which the insurer will pay you benefits while you’re disabled. (Short-term disability insurance lasts from just a number of months to a maximum of one years, while long-term disability insurance can last until you reach retirement age.)

Depending on the policy, your coverage for presumptive disability may extend even beyond your benefit period; some insurers keep making payments for presumptive disability until you die.

→ Learn more about how long disability insurance benefits last

The benefit amount is the same

Disability insurance benefits are typically paid out monthly. Because disability insurance is meant to replace your income during your disability, the benefit amount should be roughly 60% of your gross pay. Your coverage limit for total disability, as described in your policy, governs both total and presumptive disability benefits.

Presumptive disability vs catastrophic disability

Catastrophic disability coverage means you get a payment in addition to your monthly disability benefit if your disability is particularly severe. However, the provision for catastrophic disability not included in your basic disability insurance coverage; you’ll have to pay extra to add a catastrophic disability rider to your policy.

While the terms of the catastrophic-disability rider may differ from insurer to insurer, for the most part you’ll only qualify to receive the benefit if:

  • You have a presumptive total disability

  • You have severe cognitive impairment

  • You can’t perform two or more daily living activities, such as bathing, using the bathroom, eating, or moving out of a chair, wheelchair, or bed.

However, while presumptive disability insurance benefits last your whole life, catastrophic disability benefits only last until the end of your maximum benefit period, even if you qualified for catastrophic disability because you were presumptively disabled.

Frequently asked questions

What does presumptive disability mean?

Presumptive disability refers to medical conditions that are obviously or easily presumed to be a total disability.

What is an examples of a presumptive disability?

Presumptive disabilities include blindness, total hearing loss, and loss of speech or limbs. The Social Security Administration includes more presumptive conditions, like cerebral palsy, that can qualify SSI recipients for expedited disability benefits.

What is presumptive status?

The Department of Veterans Affairs has a list of qualifying presumptive conditions, or disabilities caused by military service. For example, psychosis is considered a presumptive disability for former prisoners of war.