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.
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.
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.
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.