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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.

When you have disability insurance and become disabled, your insurer will pay you monthly benefits until you recover, or for a length of time called the benefit period. With long-term disability insurance, you can choose a benefit period as short as five to 10 years or that lasts until you’re age 65 or 67.

Disability insurance will pay out 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 disability insurance policies also include a provision for presumptive disability, which pays out your full disability insurance benefits, potentially for life, if you receive a disability so severe that total disability can be presumed.

As defined by disability insurance companies, presumptive disability means:

  • Loss of speech
  • Loss of hearing
  • Loss of sight in both eyes
  • Loss of at least two limbs

Presumptive-disability insurance also works in tandem with the catastrophic disability rider, which is optional coverage that pays additional benefits if you’re presumptively disabled or require assistance for daily living.

Read on:

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 rider.

To make sure your disability insurance covers presumptive disability, talk to a licensed representative at Policygenius, who can make it easy to find a policy that covers these extreme disabilities.

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 is one way of describing total disability coverage, except 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.

If you’ve recovered enough by the end of the waiting period to go back to your job, then you may not be eligible for benefit payments.

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

The benefit period for presumptive disability may last your whole 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. If your coverage for presumptive disability doesn’t last that long, it will still last for the maximum benefit period you chose when taking out the policy.

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.

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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.

As with the terms of presumptive disability, there is typically no waiting period to receive the catastrophic-disability benefit.

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

Policygenius’ editorial content is not written by an insurance agent. It’s intended for informational purposes and should not be considered legal or financial advice. Consult a professional to learn what financial products are right for you.

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