“I’m Covered, I Have Group LTD!” A Real Cause For Concern. What You Need To Know!

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Are You Covered?

“YES, I HAVE GROUP LONG-TERM DISABILITY!”

CAUSE FOR CONCERN red Rubber Stamp over a white background.

“Group LTD is like a bungee cord.  Will it be dependable when needed the most?”

I’M COVERED!  Yes, you may have group LTD coverage and if you’re among the roughly one-third of Americans who get group LTD coverage through their employers, many high-level executives, business owners, and professionals believe their group LTD benefits provide them full coverage.  

I think in learning about group LTD here you will realize that not all disability insurance is created equal, and if there was ever misleading terminology when it comes to insurance coverage.  It’s likely to be found in group LTD.

How beneficial do you think this type of coverage is when it’s free or modest premium payments are being deducted from your paycheck?   

Free, cheap or inexpensive group disability coverage has too many deficiencies and restrictions that simply benefit the insurance company rather than you!

“LESS EXPENSIVE CAN BE MORE EXPENSIVE AT CLAIM TIME.”

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The bottom line is never the premium and always the fine print!

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Do you want to know when most people become an expert in disability insurance at the time of a claim, which is the wrong time?  Sadly, they discover how the narrow language provided in group LTD plays out and allows more valid claims to be denied by the insurance company.

Imagine the frustration and ongoing aggravation when you expect to be receiving income when disabled?  Only to receive the crushing news, the claims department is taking the position the language of the group LTD prevails and your claim is being denied.  Thus making a bad situation worse when your ability to work has been changed by an illness or injury and you need these disability dollars the most.

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DISABILITY CLAIMS VERSES LIFE INSURANCE CLAIMS (UNDERSTANDING THE DIFFERENCE):

DEATH CLAIM under a life insurance policy is usually paid to the designated beneficiary with very few questions asked and very little left to the interpretation of what caused the death.  A death certificate is submitted along with a claim form and the beneficiary is paid money.

DISABILITY CLAIM is much different.  Every disability claim has its own set of circumstances determined by the claimant and at times the subjective nature of disabilities.  What illness or injury is preventing you from working and doing the duties of your occupation?  Less favorable wording works against you at claim time and will be determined and interpreted by the claims department.  You may have a legitimate disability claim but the restrictive language will make it harder to collect benefits when the need is the greatest.

I will repeat this throughout this section.  

NO to LOW premiums and the fewer underwriting (medical) questions asked to get accepted WILL NEVER PROVIDE THE BEST DISABILITY COVERAGE FOR YOU, and YOU’LL ALWAYS GET WHAT YOU PAY FOR  when comparing group LTD to an individually underwritten income insurance policy.     

My goal is to help educate potential or high income earning employees, business owners, executives, and professionals regarding the restrictive language, definitions, limitations, caps, gaps, other income and taxation of group LTD before you ever have a claim.  In addition, how individual disability insurance can benefit you.  Ideally, you want the most favorable benefits, contractual provisions, and definitions protecting your most valuable asset.  Your ability to earn an income in your occupation!

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WHY CAN GROUP LTD
BE BAD FOR YOU?

HERE ARE SOME KEY POINTS
AND COMMON MISTAKES!

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Group LTD is consistent in its terms of DEFICIENCIES and SHORTCOMINGS.

You can expect to receive more LIMITED and RESTRICTIVE LANGUAGE / COVERAGE when NO to LOW premiums are paid and NO or a FEW medical questions are asked in the approval process.

Group LTD plans are less flexible than individual disability plans even though they may appear to have many of the same features.

Group LTD insures only your base salary and not other income you earn.  A disadvantage to high income earning executives, business owners, and professionals.

Group LTD claims reduce your monthly benefit by other income.  A disadvantage to everyone.

The employer is owner and controls coverage, which is written for the group, not the employee.

The employee usually does not have the ability to select the level of coverage appropriate to their personal situation.

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When the group has some claims and the claims experience to the insurance becomes too high, thus reducing their profitability.

Anything and everything can change upon renewal!

(1) Benefits can change.

(2) Premiums increase.

(3) Cancellation by the company.

There are no guarantees provided with group coverage, which is more like a rental agreement that is subject to change.  Group LTD premium rates also increase as the average age of the group rises.

Guaranteed contracts and premiums are provided only with individual policies, and if group rates were guaranteed the cost to all employees would be much higher and underwriting more difficult.     

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IMPORTANT QUESTIONS TO ASK YOURSELF!

Would you have disability insurance if it wasn’t offered to you by your employer?

Would you go out and purchase an individual policy if your employer didn’t offer group LTD?

Have you ever reviewed your group LTD benefits?

Do you understand the limitations of how your group LTD benefits work?  Most don’t!

Free or inexpensive can be very deceptive when you don’t understand what you think you have?

Do you contribute a premium to your group LTD benefits?

Do you think it makes sense to own income insurance protection without having it tied to your employer?

Do you see yourself changing jobs in the future?

How would you feel if you lost your group LTD and you couldn’t qualify for an individual policy?

“THE GROUP POLICY LANGUAGE” CONTROLS THE CONDITIONS
UNDER WHICH A CLAIM WILL BE PAID:

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WHY CAN GROUP LTD
BE BAD FOR YOU?

HERE ARE SOME KEY POINTS
AND COMMON MISTAKES!

Read the Fine Print Words Magnifying Glass Warning

Policy wording governs the conditions under which a claim will be paid.  It is very important to understand the fine print and many limitations in group LTD coverage to your detriment regardless of your status in the company.  

Here’s why!  The bottom line isn’t the premium.  It’s always the fine print!

TIP:  Request to read your group policy.  Learn more in “Understanding Disability Insurance Lingo, Language, Benefits and Terminology”.

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THE DEFINITION OF TOTAL DISABILITY
(ADVANTAGE THE INSURANCE COMPANY):

You are an architect and seriously injured your right arm, hand, and back in a terrible automobile accident at age 40.  You’re right-handed and can’t work performing the material and substantial duties of your occupation.  You’ve been on the employer’s group LTD plan and relieved to know you have disability insurance.  You have filed a claim and you have met the plan’s waiting period.  Your group LTD coverage states benefits are payable to age 65.  You’re dealing with your disability and trying to get better believing in the worst case you will be receiving benefits for the next 25 years.

It’s here you learn how a group LTD plan actually pays disability benefits to you and the unfortunate downside to this type of coverage.
The standard definition of disability for most group LTD provides for an initial period with one type of occupation definition, then transitions into a different definition for the rest of the benefit period.  Normally, the first 24 months of your policy may be covered as an OWN OCCUPATION disability insurance policy where you can’t perform the substantial and material duties of your job, disability benefits are paid to you for the first two years if the disability lasts that long.  Should the disability continue after that period of time, the policy redefines the definition to a narrower and more restrictive can’t work in ANY OCCUPATION for which you are deemed reasonably qualified by education, training, or experience.

This definition of disability will penalize you if you can go back to work in ANY OCCUPATION, or more limiting, the claims department at the insurance company might deem you capable of going back to work in ANY OCCUPATION based on education, training, and experience.  You can expect your monthly disability benefits to stop.

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Let’s use the example of the disabled architect above with the initial definition of OWN OCCUPATION for 24 months and ANY OCCUPATION thereafter.  The claims department has the right to re-examine your injuries and determine whether you are qualified and able to work in any other occupation based on education, training, and experience.  Can you teach college graduates in architecture?  Can you do research work at the university level or with a company that requires architecture knowledge?  The insurance company under the group’s definition of disability has the right to stop paying your ongoing monthly disability benefits if they believe you can work in another occupation.    

Here’s another example:  You’re a pilot and can’t fly planes anymore because of your disability under the OWN OCCUPATION definition (24 months) stated in your group LTD coverage.  The claims department determines after (24 months) you are able to teach others to be a pilot under the ANY OCCUPATION definition, your monthly disability benefit is likely to stop.

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GROUP LTD POLICIES ARE OFTEN DESIGNED THIS WAY.  WHY?

These split definitions give the insurance company more control over claims and help keep premiums low under group LTD coverage.  Remember NO or LOW premiums don’t benefit you at claim time, and the bottom line is never the premium.  It’s always the fine print!  

NOTE:  depending on the different occupation classifications of the group, the following definitions for total disability might provide OWN OCCUPATION for 2 to 5 years, thereafter the definition changes to working in ANY OCCUPATION.  Certain professional or executive occupation classes within the group may receive a more favorable OWN OCCUPATION definition to age 65.

TIP:  Some group LTD coverage may add a word or two during the more favorable OWN OCCUPATION definition to make it harder to collect disability benefits depending on what your employer selected as coverage for its employees, also look closely for wording that states ANY OCCUPATION.  However, due to the competitive nature of group LTD, the language needs to be relatively favorable to the marketplace.

RESIDUAL / PARTIAL DISABILITY:  Most disability insurers will work with employers to help you return to work as quickly and safely as possible. While disability insurers want to see people healthy and rehabilitated, they also save money if a claimant quickly returns to work.

You’ll most likely find your disability insurer managing the claim if you’re “partially disabled” — meaning you can still work but are earning less than your pre-disability earnings.    

The insurance company will pay a percentage between 20 and 80 percent of your pre-disability earnings.  You will receive a proportionate monthly disability benefit based on the percentage of earnings lost.  

Where you’re only able to earn less than 20 percent of what you previously made, you’ll likely get full disability benefits based on your pre-disability income.  When you can earn more than 80 percent of your pre-disability income, most group LTD plan will not consider you disabled.  

Example:  Your group LTD benefits are 60% of salary with a $5,000 maximum monthly benefit.  You’re partially disabled performing limited work. Your salary was $100,000 x 60% = $60,000 (Annual Disability Benefit) / $5,000 (Monthly Disability Benefit).  You’re able to earn 50% of your pre-disability monthly earnings ($8,333).  You will received 50% of $5,000 = $2,500 in monthly partial disability benefits.  

THE “CONTINUOUS” WAITING PERIOD:  All group LTD coverage has a “waiting period” between the time your disability occurs and when you can begin receiving benefits.  This is essentially a period-of-time during which you’re not yet eligible for LTD benefits.

Consider this scenario.  What happens if you return to work for one day during your 90 or 180 day continuous waiting period?  One day back at work requires the waiting period to start all over again.  This is not favorable to you at claim time and found in most group LTD plans.

MONTHLY BENEFIT CAPS,
OTHER INCOME & GAPS =

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It benefits you to understand CAPS and GAPS for high-income earners covered under a group LTD plan!

PROBLEM 1 (CAPS):  Basic group LTD coverage usually CAPS benefits at 60% of salary only (not other income) to a maximum monthly benefit anywhere from $5,000 to $15,000 with higher monthly benefit amounts ($20,000 to $35,000) available for certain types of business and occupation classes.  

Group LTD tends to hurt highly compensated executives or professionals when monthly benefits CAPS are too low ($5,000 to $15,000) with no additional coverage.  It leaves these key employees underinsured should a disability occur.

Group LTD tends to hurt these same highly compensated executives or professionals when monthly benefits CAPS are too high ($20,000 to $35,000) and may prohibit these key employees from getting better individual coverage due to over insurance.  Other issues of high CAPS are the limitations and restrictions in the language with this type of group coverage.  You will always want a better individual contract, if you can qualify, to protect your income.

PROBLEM 2 (SALARY ONLY / NO OTHER INCOME):  Your group LTD monthly benefits are calculated based on SALARY ONLY and do not include OTHER forms of INCOME or compensation, which can often make up a significant portion of your annual pay.  This means that highly compensated employees, executives or professionals who earn significant amounts of bonus income or other incentive pay may have less LTD coverage than they think and face a large income gap if they become disabled and can’t work.  

TIP: You want to find out from your human resource department or the person in charge of your employee benefits what other types of income are not covered under your group LTD plan?

PROBLEM 3 (GAPS):  Group LTD provided through your employer should be a basic foundation for all employees of the company.  However, it leaves GAPS where higher income earning employees may be at greater risk should a disability occur.  The more you earn beyond salary the more income discrimination you face should a disability strike.

A good way to make up the difference is with a better individual disability income policy.  (IIP) Individual income protection fills in the GAPS left by group LTD.

PROBLEM 4 (REVERSE DISCRIMINATION):  Highly paid employees, executives, and professionals may not realize their current LTD plans only replace a small percentage of their income.  This is not a good situation in view of the fact one’s lifestyle and standard of living are based on 100% of pre-disability earnings.    

(1) Consider a group LTD plan that covers 60% of salary to a maximum of $5,000 a month covers 60% of salary for those employees earning up to $100,000.  The LTD benefit CAP means an executive or professional earning $150,000 in salary has coverage of only 40%, falling to 30% for an executive or professional earning $200,000 in salary.  What if your salary is $300,000 or $400,000?  The effect of CAPS and GAPS on LTD benefits is referred to as “REVERSE DISCRIMINATION” on pre-and post-disability earnings.

(2) Here’s another example where a group LTD plan that covers 60% of salary to a maximum of $6,000 a month provides a maximum benefit to someone with a $120,000 salary.  An employee at this company earns $130,000 based on $90,000 in salary and $40,000 in bonus compensation.  This person would only receive $4,500 in monthly disability benefits and is faced with “REVERSE DISCRIMINATION” since LTD benefits cover only the salary of $90,000.  This employee’s income replacement percentage is 42% of total compensation with other bonus income not insured in the event of a disability.

(3) More CAPS and GAPS for highly paid employees, executives, and professionals.  You’re earning $500,000 with $400,000 in salary plus $100,000 in bonus income (not insured).  $500,000 / $41,666 pre-disability monthly earnings including $100,000 bonus. $15,000 maximum monthly group LTD benefits.  $41,666 x .36% = $14,999.  You’re only insuring 36% of your full compensation.  MORE “REVERSE DISCRIMINATION” and heavily underinsured.  

What makes these 3 situations worse if the premium was non-contributory (employer pay).  YOUR DISABILITY BENEFITS ARE TAXABLE INCOME FURTHER REDUCING THESE AMOUNTS.

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(OFFSETS) REDUCTION OF BENEFITS AND OTHER INCOME AT CLAIM TIME / FURTHER LIMITATIONS:

TIP:  Review and look closely at your group LTD coverage and see how the plan reduces benefits by other income at the time of claim.  This is a surprise to many when realizing your monthly disability benefit is not really your monthly disability benefit at claim time.

Group LTD takes into consideration other income and reduces your monthly disability benefit depending on your plan.  Standard offsets and reductions can be social security, state disability, worker’s compensation, benefits received under a retirement plan subject to a disability, unemployment benefits and in some situations even individual disability insurance.

This is generally not the case with individual income protection policies, which doesn’t offset at claim time unless a social security substitute has been applied for and issued.

TAXATION OF GROUP LTD BENEFITS:

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Another problem that can occur with group LTD coverage is the taxation of your disability benefits when your employer pays the premium (non-contributory).  The employer gets a tax deduction for the LTD premium paid to the insurance company and you get to pay taxes on your disability benefits, which can take a significant bite out of your benefit payments.    

NON-CONTRIBUTORY (EMPLOYER PAY):  Your disability benefits are taxable income to you when your employer pays the entire premium.  The plan is said to be non-contributory.  You cannot opt out of the group LTD coverage.  One hundred percent of all eligible employees must be covered if the plan is non-contributory.

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CONTRIBUTORY (EMPLOYEE PAY):  Your disability benefits are non-taxable for the portion of the premium you pay through payroll deduction to your employer.  Your group LTD is said to be contributory if you pay either part or all of your premium cost.  Premiums for group long-term disability are usually very inexpensive and well worth picking up the cost to receive income-tax free benefits.  You may also be allowed to opt out of coverage for a better individual policy.

PRE-EXISTING CONDITION LIMITATIONS:  It should be obvious why group LTD plans contain standard pre-existing condition limitations.  This provision is designed to protect LTD plans and the insurance company from the impact of additional claims that would result if an employee with a pre-existing medical condition joins the group LTD plan or chooses to join the plan in an attempt to collect disability benefits quickly.    

What is a pre-existing condition?  They are defined as any injury or sickness for which a person incurred charges, received medical treatment, consulted a physician or took prescription drugs for any underlying medical condition.  There may be additional wording for symptoms that a prudent person would have sought or required treatment.

How far does the group LTD plan look back prior to the effective date of coverage to determine a pre-existing condition (90, 180, 365, or 720 days)?  If such a medical condition is present, you will not be eligible for disability benefits until you have been covered under the plan for (90, 180, 365, or 720 days)?  Pre-existing medical conditions would be covered after this stated number of days.

Example:  You signed up for coverage effective January 1 and were diagnosed with a melanoma 10 months early in February.  The group LTD plan looks back 12 months and requires you to be on the plan for 12 months.  Therefore any disabilities related to the pre-existing melanoma condition would be covered on January 1 of the following year.

TIP:  Make sure you read and understand the group pre-existing condition limitations.

OTHER BENEFIT LIMITATIONS:  A 24-month limitation on disabilities caused in part by alcoholism, drug abuse, or mental or nervous conditions is paid when these conditions cause a disability.

PORTABILITY:  Is your group LTD coverage portable upon termination of employment?

Most group LTD plans end and “YOU CAN’T TAKE IT WITH YOU” when you terminate employment.  This is a serious deficiency especially when you have had a change in health and desire maintaining disability insurance upon leaving your current employment for another career opportunity. Your options may be limited for individual coverage.    

Some group plans will allow for portability of coverage.  IMPORTANT!  What are they allowing you to take with you, what are the benefits, terms, and premiums?  Do you have to go through medical underwriting to take disability coverage with you?

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PLANNING TIPS

WHAT CAN BE DONE TO FIX THE OBVIOUS FLAW IN GROUP LTD?

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The recommended planning approach is to own individual policy with its many advantages.  This can be done in a number of ways providing an important primary or secondary level of income protection.      

The first two are done in advance prior to being covered by a group LTD plan creating a primary level of income insurance planning protection.  The third and fourth are options while covered under a group LTD plan creating a secondary level of income insurance planning protection.

(1) Purchase an individual policy in graduate school or a professional residency program prior to starting your career.    

(2) Purchase an individual policy before employment where group LTD is offered.  

(3) Opt out of your current group LTD plan if it’s a contributory plan and purchase an individual policy.

(4) Carve out a plan for key employees, business owners and professionals with higher salaries and other income to be insured under a multi-life situation.  This can be done by redesigning the group LTD plan with lower monthly disability benefit levels and changes to contributory and non-contributory participation requirements if necessary.  Various benefit levels and underwriting programs can be selected depending on the number of employees applying for individual policies from fully underwritten, simplified issue to guaranteed issue.  

Generally, group LTD should provide a base for all employees ($5,000 to $10,000 maximum monthly benefit) allowing higher earning executives, business owners and, professionals to supplement this coverage with better individual coverage.

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This solves a couple BIG problems for highly compensated executives, business owners, and professionals.

“REVERSING INCOME DISCRIMINATION” with a higher percentage level of income protection.

A good individual policy provides you with much more financial security.  You OWN a more favorable / valuable contract with better policy provisions and definitions protecting you at claim time while guarding your most important asset.  Your ability to earn an income in your occupation!

What about the other deficiencies of group LTD, such as portability, premium rate, and coverage changes?  These inherent flaws of group LTD are also corrected by a good individual policy.  You simply don’t want to rent this important coverage allowing it to be changed or cancelled beyond your control.

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KEY THOUGHT:  A good individual policy will allow a disability claim to be paid under more situations, conditions, and circumstances that benefit you.

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ADVANTAGES OF PURCHASING (IIP) BEFORE GROUP LTD

PLANNING TIP:  Why an Individual Policy Before Group LTD?

The insurance company for an individual policy takes into consideration all disability insurance in-force during the processing of an application for individual disability insurance, which includes all disability insurance including any group LTD.  The concern is over insurance and eliminating the incentive to become disabled.  When there is no other disability insurance or group LTD in-force.  The company will issue you a level of coverage based on your taxable income.    

When there is group LTD in-force, the company will reduce the amount of individual coverage based on how much group LTD is in-force and your current level of taxable income.  The greater the LTD benefit available through an employer and your taxable income, the individual disability benefit will be adjusted downward with the possibility of nothing being offered due to over insurance.        

Now, what happens when you purchased an individual disability policy and it’s in-force for a period of years, and you accept a new job opportunity where group LTD is an included benefit.  There are no issues because group LTD requires no underwriting asking if you have any disability insurance currently in-force.  The only issue might be at claim time if the group policy considers other income to be other disability income as a way to reduce their group disability coverage.

HERE’S ANOTHER VALUABLE INCOME PLANNING PROTECTION  TIP!

You were able to purchase an individual policy early in your career at age 30 with future insurance options included in your policy.  There was no other coverage at the time your policy became effective.  Fast forward, you’re age 40 and leaving your current employer for another career opportunity and losing your group LTD.

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Here is the value of future insurance options included in an individual disability insurance policy.  Let’s assume at age 38 you experienced a significant change in health, impacting future insurability.  This next career move at age 40 is a start-up paying you more and they do not offer group LTD coverage.

You can purchase an increased amount of personal disability upon losing your group LTD.  The only requirements are income verification at your attained age, how much personal disability insurance you have in-force with group LTD soon to be zero, and how much will the company issue based on current income.  New individual disability insurance is subject only to administrative approval with NO MEDICAL UNDERWRITING regardless of your significant change in health a couple of years ago.  

Some companies allow you to purchase an increased amount of personal disability insurance upon losing your group LTD, which is referred to as an “off anniversary” option.  If not, you can purchase these future insurance options on your policy anniversary subject to issue / participation limits and income verification also with NO MEDICAL UNDERWRITING.

Future insurance options are a great solution when leaving a current employer for a future career opportunity with no group LTD or even group LTD you can opt out of (contributory).      

HOW VALUABLE ARE FUTURE INSURANCE OPTIONS?  PRIZED, IMPORTANT, AND EXTREMELY BENEFICIAL TO YOUR FUTURE!   

GROUP LTD AN INDIVIDUAL DISABILITY INSURANCE POLICIES ARE NOT CREATED EQUAL

You should now understand narrow, limited or restricted language found in group LTD coverage benefits the insurance company at claim time, not you!

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Group LTD is marketed as a promise to pay and ends up, many times, being a promise to not pay due to the strict nature defining the definition of disability and other deficiencies found in this coverage.  

I have stated throughout this section and will repeat it one more time.  The phrase YOU GET WHAT YOU PAY FOR, NO, let me restate that you DEFINITELY GET WHAT YOU DON’T PAY FOR OR PAY A LITTLE FOR and these words are never truer when it compares the difference between renting group LTD and owning a more comprehensive individual disability income insurance policy.

BUY YOUNG AND PURCHASE (IIP) INCOME INSURANCE PROTECTION GUARANTEES EARLY!  Owning an individual income protection policy is in your best interest and benefits you throughout your working and professional career.

HERE ARE ADVANTAGES OF OWNING (IIP) INCOME PROTECTION THROUGHOUT YOUR WORKING AND PROFESSIONAL CAREER VERSE RENTING GROUP LTD:

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An individual policy provides the most comprehensive coverage.  Premiums and contract are guaranteed to age 65 and cannot be changed or canceled except for non-payment.

Coverage is portable if you leave your employer you keep the policy.  You own the policy whether you change employers or not in the future.

You always want better individual income protection with the most favorable definition of disability protecting your occupation and ability to earn an income.  Contractual provisions and language mean everything, especially at claim time.

IIP insures a greater portion of all pre-disability earnings and considers contributions to retirement plans as income.

You want to own a policy with guarantees not rent a benefit that is subject to change.

Flexibility and policy customization.  Many different types of benefits and options are available on individual policies.

Tax-free benefits.  When you pay the premiums with after dollars, disability benefits received are not taxed.

However, at claim time, the contractual provisions will always prevail, which is why an individual policy is much better than free or inexpensive group LTD.

There is simply no comparison between group LTD coverage and a good individual DI policy with guaranteed premiums and more favorable terms, contractual provisions and additional benefits than group LTD plans.

A formal salary wage continuation plan funded by DI insurance helps avoid key tax issues and other potential financial problems.

Marc Maretsky Personal Insurance Services based in Beverly Hills, serves all of California and the United States.  I help my clients acquire life, disability, long-term care, and critical illness insured solutions, as well as enroll them into Medicare when eligible.

“No matter how fast technology changes our world and everything around us.  I believe the personal touch and a human voice are more important than ever.”

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