Chapter 7:  Return To Work Issues

Recurrent Disability

A recurrent disability is a period of disability, which results from the same or a related cause of a prior disability. For example, if a box of copy paper fell on your foot, resulting in a broken foot, which disabled you from work, that time out of work would be one period of disability. If you were somewhat better and returned to work, but began to experience pain from that same injury and had to stop work again, that second disability claim is a recurrent disability. The same accident and injury is the ultimate cause of both disability periods. 

To further explain, let us look at what is not a recurrent disability. If you had this foot problem and you were out of work, but then after returning to work you experienced a neck injury which left you disabled, this neck injury keeping you out of work does not stem from the same injury. That may not be a recurrent disability.

The benefit of the recurrent disability provision is that the insured does not have to start over again with an elimination period. For example, if the elimination period is 180 days, that could really hurt financially to wait out a second 180 day elimination period before benefits start.  

Here is an example of a recurrent disability provision:

RECURRENT DISABILITY

A Recurrent Disability will be treated as part of Your prior claim and You will not be required to satisfy a new Elimination Period if:

a) You were continuously insured under the Policy from the date benefits ended for Your prior claim to the date Your Recurrent Disability begins; and

b) Your Recurrent Disability occurs within 180 days after the date benefits ended for Your prior claim.

This provision is often unfair, given the insured is the one who has suffered and paid premiums for all his own policies. In order to prevent over-insurance because of duplication of benefits, benefits payable under this Recurrent Disability provision will cease if benefits are payable to You under any other Policyholder or Affiliated Company sponsored group long-term disability income policy or plan.

There is a danger that arises with the definition of recurrent disability. It typically has time limits as to how long you can make a return-to-work attempt between the first period of disability and the second period of disability. The time limit is set as stated in the policy. Frequently I see six months. If you return to work after a disability, and your return lasts for longer than six months, and then again you must leave on disability, you will miss out on the protection of the recurrent disability provision as defined above. It does not matter if you are out again for the same injury or not. If you exceed that time limit of 6 months, you will wait another 180 days of elimination before benefits are paid.

People will often make the mistake of engaging in heroic efforts to push a work attempt too long. When it is clear you are declining, talk with your doctor. If one pushes just a little too long, he could end up without benefits while going through a second elimination period all over again. Working just one day over that time limit can lose several months of benefits.

Waiver of Premium

This term refers to a provision in a policy, or a rider or addendum to the policy, which allows for the insurance to continue free of charge if the insured is disabled. The waiver of premium benefit allows the long-term disability insurance to stay in place without the insured paying for that benefit. If the disability benefit is terminated, a second claim can be filed.

For example, if the insured recovers and goes back to work, the insured can resume paying for the insurance and does not have to reapply for insurance all over again. After having a physical problem there may be difficulties in obtaining a new long-term disability policy and so this provision protects the insured from that possibility. If a relapse occurs or another sickness or injury, the policy is in place to pay the insured again.

An example of this provision is as follows:

Waiver of Premium: We waive your premiums for this coverage while you were entitled to receive a monthly benefit payment from this policy.

Typically a policy with this provision may cost more, but it is worthwhile to have to allow return to work attempts.