Hayley Kai Fundementals - Chapter 11

caused by
a)accidents- at work WCB offers no fault benefits away from work accident/sickness purchased
b) sickness- leading cause of disabilities
WCB offers when from industrial cause , away from work A/S needed
3 types: any occupation, regular occupation,own occupation

effects the type of disability policy for an individual A/S contract

any occupation - limited definition. benefits are not payable if insured is able to engage in any occupation that they are reasonably fitted for
Regular occupation
own occupation - broadest definition. If insured is unable to perform duties for regular occupation, full benefits will continue to be paid even if they begin working at new occupation

premiums for plans are paid by employer. premiums determined by occupational risk ( welding vs book store)
covers: 1) any necessary health costs
2) medical/vocational rehab
3) replacement for lost earnings ( up to 90% net)
4)death benefit

1) individual insurance - for self employed,high income. offers disability policy - monthly income to insured. payments start after elimination period is satisfied and ends when insured recovers, dies or end of benefit period. has 4 characteristics
2) group insurance - employer purchases policy to cover all employees. has two types : weekly indemnity and long term disability

1) claims cost - type of policy , applicants personal info ( age , sex , occupation ) and type of benefits requested ( benefit period, elimination period, definition of disability)
2) operating costs
3) investment earnings

period of self insurance between the onset of disability and commencement of disability benefit.
used to determine premium depending on when requested .
determines when monthly payments from disability policy of individual A/S insurance begin

period which benefits are payable. 1 year up to the "age of 65"
used to determine premium depending on when requested .determines when monthly payments from disability policy of individual A/S insurance end

1) application forms part of contract - contract includes application , policy and amendments
2) Insurable interest required
3) incontestability - statements made on individual a/s contracts are incontestable ( can not be challenged) after 2 years . EXCEPT: fraudulent statements and misstatement of age
4) unpaid premiums - insurer is entitled to deduct amount owning (from unpaid premiums ) from claim amount

there are 2 types
1) weekly indemnity - short term coverage . typically payments made for 13, 26, or 52 weeks
2) long term disability -
a) major medical ( extended health care )- reimburses insureds/dependents for expenses ( prescriptions or ambulance )
b) dental plan
c) accidental death / dismemberment

1)policies can be purchased as single trip or annual basis ( 30,60,90 or 180 days as max)
2) classifies dependents as under age 20 ( 26 if in school ) unmarried, fully supported
3) incidental coverage - expenses incurred by accident / injury( trip interruption, cancellation)
4) does not cover pre existing conditions. ( some policies will if has been under control for 3 or 6 months)