The following definitions apply to the policy and riders as approved in most states. Definitions may vary by state.
Activities of Daily Living (ADLs)
There are certain basic daily tasks necessary to maintain an insured’s health and safety. For this rider, ADL refers to the activities described below:
- Bathing means washing oneself by sponge bath or in either a tub or shower including the task of getting into or out of the tub or shower.
- Continence means the ability to maintain control of bowel and bladder function; or, when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene (including caring for catheter or colostomy bag).
- Dressing means putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs.
- Eating means feeding oneself by getting food into the body from a receptacle (such as a plate, cup or table) or by a feeding tube or intravenously.
- Toileting means getting to and from the toilet, transferring on and off the toilet, and performing associated personal hygiene.
- Transfer and mobility means the ability to move into or out of a bed, chair or wheelchair or to move from place to place, either via walking or using a wheelchair, cane, crutches, walker or other equipment.
Any Gainful Occupation
Is an occupation, which fits the insured by education, training or experience and replaces or is expected to replace 60 percent or more of an insureds prior monthly income.
Cognitively Impaired
Deterioration or loss of ability to think, perceive reason or remember, which calls for another person’s help or prompting to protect themselves or others. It is measured by clinical evidence and standardized tests approved by the insurance carrier that reliably measure such impairment. The loss in mental capacity must be a result of a sickness or injury, including Alzheimer’s disease, dementia and organic brain damage caused by an accident or head trauma.
Concurrent Disabilities
Disabilities caused by more than one injury or sickness, whether they are related or not.
Elimination Period
The number of consecutive days the insured must be totally disabled before they are eligible to receive the benefits.
Employed on a Full-Time Basis
Working for pay for at least 30 hours per week.
Guaranteed Renewable
Coverage is guaranteed renewable to the termination date as long as the premium is paid on time. No provision of the policy can be changed by The Standard, except for the premium, before the termination date. The premium can be changed only after the policy is three years old1 and then, only if the change applies to all policies with similar benefits insuring the same risk class.
Home Modification Benefit
If the insured is totally disabled and has been receiving total disability monthly benefits for six consecutive months, the actual costs up to six times the base policy monthly benefit during their lifetime will be paid towards modification of their existing residence to accommodate their disability. Modifications must begin while the insured is totally disabled.
Maximum Benefit Period
The maximum period of time any combination of total disability monthly benefits (base policy monthly benefits) and partial disability monthly benefits, if any, are paid.
Monthly Income
The insured’s monthly gross income earned from their occupation including salary, wages, bonuses, commissions, fees and other pay for personal services.
If the insured is self-employed or owns a business, monthly income is their share of gross income earned by the business, plus any salary or draw from the business, minus their share of normal and customary business expenses specified as deductible for tax purposes.
Occupation Classification
Are the guidelines insurance carriers use to determine an insureds rate classification and benefit availability. Each job with similar duties and risks may affect coverages and rates. For example a roofer would be a higher risk than a trucker, but a trucker is a higher risk than a nurse. Therefore, a nurse’s premium based on occupational classification would be more affordable than a roofer or a trucker.
Own Occupation
The occupation in which the insured is engaged at the time their disability begins.
If the insured is unemployed one year or less from the time their disability begins, own occupation will be the occupation in which they were engaged prior to becoming unemployed. If they have been unemployed for more than one year, own occupation will be an occupation which fits them by education, training or experience.
Partial Disability
If the insured is partially disabled and has resumed part-time employment immediately following a period where they received total disability monthly benefits, this benefit will be paid. Benefits will continue until the insured is no longer partially disabled or to the end of the maximum benefit period, whichever is first, but no longer than six months. The partial disability monthly benefit is 50 percent of the base policy monthly benefit.
A degree of disability due to a sickness or injury which:
- starts while this policy is in force;
- requires a physician’s care unless the insured’s physician certifies they have reached the maximum point of recovery;
- for the first two years after the elimination period, keeps the insured from doing one or more, but not all, of the substantial and material duties of their own occupation or results in the loss of 25 percent or more of the time spent by them in the usual daily performance of the duties of their own occupation; and
- after total disability and any partial disability benefits have been paid for two years, keeps the insured from doing one or more, but not all, of the substantial and material duties of any gainful occupation or results in the loss of 25 percent or more of the time spent by them in the usual daily performance of the duties of any gainful occupation.
Pre-existing Condition
A sickness or physical condition for which, during the two years before the issue date, the insured:
- had symptoms which would cause an ordinary prudent person to seek diagnosis, care or treatment; or
- received medical consultation, advice or treatment from a physician or had taken prescribed medication.
Presumptively Disabled
If the insured is presumptively disabled, the total disability monthly benefit will be paid regardless of the insured’s ability to work and whether or not they are under the care of a physician. The elimination period does not need to be satisfied for the insured to receive the benefit.
The insured’s permanent and irrevocable loss, because of their injury or sickness, of one of the following: speech, hearing in both ears, sight in both eyes, use of both feet, use of both hands, or use of one hand and one foot.
Permanent and irrevocable loss of sight means both of the insured’s eyes measure at or below 20/200 after reasonable effort has been made to correct their vision using the most advanced medically acceptable procedures and devices available. Permanent and irrevocable loss of hearing means hearing in both ears cannot be restored by hearing aids. The insured will be considered totally disabled if they are presumptively disabled.
Prior Monthly Income
The greater of:
- the insured’s average monthly income for the one-year period immediately prior to their disability; or
- the insured’s average monthly income for the calendar year with the highest earnings of the last two calendar years prior to their disability
Recurrent Total Disability
A situation, in which the insured becomes totally disabled, ceases to be totally disabled and then becomes totally disabled again from the same or related sickness or injury. The latter total disability will be considered a recurrent total disability.
Residual Disability
A degree of disability due to sickness or injury which:
- starts while this rider is in force;
- requires a physician’s care unless the insured’s physician certifies they have reached the maximum point of recovery;
- results in the insured’s loss of at least 20 percent of their prior monthly income;
- for the first two years after the elimination period, keeps the insured from doing one or more, but not all, of the substantial and material duties of their own occupation; and
- after benefits have been paid for two years, keeps the insured from doing one or more, but not all, of the substantial and material duties of any gainful occupation.
If the insured is totally disabled, they are not residually disabled.
Total Disability
A disability due to sickness or injury which: If the insured is totally disabled and the elimination period has been satisfied, this benefit will be paid. Benefits will continue while the insured is totally disabled or to the end of the maximum benefit period, whichever is first.
Total disability monthly benefits will be paid for only one of two or more concurrent disabilities. Also, a recurrent total disability is considered a new total disability only if it is separated from the ending date of the prior total disability by a period of one year or more where the insured is continuously employed on a full-time basis and not receiving any disability monthly benefits. A new total disability is subject to a new elimination period and starts a new benefit period. Any other recurrent total disability is considered a continuation of a prior total disability, not subject to a new elimination period or starting a new benefit period.
- starts while this policy is in force;
- requires a physician’s care unless the insured’s physician certifies they have reached the maximum point of recovery;
- for the first two years after the elimination period, keeps the insured from doing all the substantial and material duties of their own occupation; and
- after benefits have been paid for two years, keeps the insured from doing all the substantial and material duties of any gainful occupation.
If the insured is able to perform one or more of the substantial and material duties of their own occupation for the first two years after the elimination period, or of any gainful occupation after benefits have been paid for two years, they are not totally disabled.
Waiver of Premium
Waives insureds premium during a total disability, premiums will be waived for as long as the condition lasts, and the policy will still be effective until the end of its term. All plans work differently for each carrier.
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