Disability insurance is basically income protection insurance — it can pay out benefits if an injury or illness means you’re unable to work. Certain serious disabilities, often involving the loss of sight, hearing, or multiple limbs, are called presumptive disabilities, and can qualify for special coverage.
If you have a presumptive disability, you may be able to start getting benefits from your disability insurance more quickly than with other illnesses or injuries. You may also be able to receive presumptive disability benefits for the rest of your life, even if you wind up returning to work in the future.
What is a presumptive disability?
A presumptive disability is a condition so severe that insurance companies presume that you’ll never be able to work again, or at least work again in the same way you did before your disability. It also has to be something that will likely be permanent, or have permanent effects.
The following list of conditions are usually considered to be presumptive disabilities:
Loss of sight in both eyes
Loss of speech
Loss of hearing in both ears
Loss of both hands or feet
Loss of one hand and one foot
Depending on the terms of your disability insurance policy, you may be able to keep receiving benefits after a presumptive disability regardless of whether you’re ever able to return to work.
Presumptive disability vs. other types of disabilities
A presumptive disability is just one type of qualifying disability that most standard policies cover. It’s important to know the difference between these common terms because disability insurance companies treat them differently.
Total disability: A term for a permanent or temporary disability that keeps you from doing your regular duties at work.
Catastrophic disability: A catastrophic disability is a severe disability that makes you eligible for an additional payment on top of your regular disability benefit. You need to add a special rider to receive this coverage.
What happens if you have a presumptive disability?
Insurance policies treat presumptive disabilities differently than other disabling conditions, like a broken leg from a bike accident or a cancer diagnosis. Normally, after making a claim you’d have to wait for a set period of time to pass before you can start receiving any benefits. This is called the waiting or elimination period.
If you have a presumptive disability, however, your insurance company will waive the elimination period and your benefits will start instantly.
Benefits usually last until the end of your policy’s benefit period, but you may receive benefits for presumptive disabilities for an even longer time then the typical maximum set out by your policy. Typically benefits for any disability, including presumptive disabilities, are paid out monthly.
How to get coverage against presumptive disabilities
Most disability insurance policies cover presumptive disabilities by default, so you probably don’t need to worry about finding a special kind of policy or paying extra for coverage.
Long-term disability insurance offers the best protection against loss of income because of injury or illness. It pays benefits for a year or longer — short-term disability insurance, which only covers absences of up to 12 months, won’t provide enough coverage if your disability is permanent.
If you find out your policy doesn’t include special coverage for presumptive disabilities, you may have to ask your insurance company to add a presumptive disability rider to your policy. Adding a rider, which is just a feature that changes or adds coverage to an insurance policy, may cost extra.
Before you buy a policy, compare quotes from multiple insurance companies. That way you can be sure you’re getting the disability coverage you need at an affordable price.
Presumptive disabilities and Social Security
If you have a presumptive disability, you may be eligible to receive benefits from Social Security. Depending on your condition, you may be eligible for benefits from both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
When you apply for SSI, you can receive up to six months of presumptive disability (PD) or presumptive blindness (PB) payments while you wait for your application to be processed. Presumptive disabilities make you eligible for expedited benefits, so you may receive a judgment in less time.
You shouldn’t rely on these benefits to replace your income by themselves if a presumptive disability leaves you unable to work. The average SSDI benefit is just $1,537 a month and even less for SSI, while a private disability insurance policy’s benefits usually cover between 60% and 80% of your income.
Read more about the differences between SSDI and long-term disability insurance
