The Edge Series: What Does “Schedule of Benefits” Mean?

The lawyers in our firm are focused on helping people with disability policies and ERISA claims. We want to give you the edge in understanding your policy. Today, we want to help you understand what the term “schedule of benefits” means in your disability policy.

The schedule of benefits is a heading in most policies. That title is followed by a list of the critical coverages, terms, and provisions. The schedule of benefits can be found near the front of the policy or near the back. It will list for you the amount of your benefit, the way it is calculated, how long the benefit will pay, offsets, the minimum and maximum amount of the benefit, the length of the elimination period, and the time frames applicable to different definitions.

You have to use the schedule of benefits with other policy provisions to know your coverage. The schedule of benefits can have optional coverages, and that is where the danger arises. Many clients have thought they had a certain level of coverage, only to learn at the time of disability that they lack that coverage. There can be many options. Here are a few examples:

  • If your employer provides a policy benefit of 50% of your wage, there may be an option for you to pay more for coverage, such as 60% or 70% of your wage.
  • Another option is a lifetime benefit option.
  • Some optional coverages only apply to executives in companies, while others apply to plant workers. You get the idea.

Options can vary greatly, and they can be confusing. You need to know which optional coverage applies to you and why. Do not take anyone’s word for it, but back it up with documentation. This is important to take care of now because it may be years before you rely on your policy. You may not recall all facts relevant to the option selected, or you may be too sick or injured leading to someone else taking care of your claim.

Therefore, to prevent confusion and disappointment, make sure you see your coverages listed in the schedule of benefits, and if it is not clear, then retain all papers such as initial pay stubs making the deduction, letters from the insurance company outlining the option you’ve selected, or enrollment forms. Keep those papers with your policy. Having that information helps us assist clients more quickly.

Remember our ERISA attorneys and long-term disability lawyers are here to help if you run into problems. Contact us at the first sign of trouble with your disability claim.

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