Glossary of Terms

 

Deductible - The portion of a loss for which the policy-holder is responsible. In workers' compensation, the injured individual is generally not liable for a deductible.

Deductible sources of income - Income from deductible sources listed in the plan which you receive or are entitled to receive while you are disabled. This income will be subtracted from your gross disability payment.

Dependent - A spouse or unmarried child under age 19 (if a child is a full-time student in an accredited school, age 23 or 25 depending upon the provisions of the contract). Children can include biological, adopted, foster and step who are supported by the insured.

Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition] (DSM-4) - A tool used by the medical and psychological communities to identify and classify behavioral, cognitive, and emotional problems according to a standard numerical coding system of mental disorders.

Dictionary of Occupational Titles (DOT) - A book of job classifications that specifies the duties of each job listed; maintained and updated by the U.S. Department of Labor as new jobs are created and technologies change.

Disability - A physical or mental impairment that prevents or restricts normal achievement. Something that hinders or incapacitates.

Americans with Disabilities Act (ADA) - A physical or mental impairment that substantially limits one or more of an individual's major life activities; also having a record of such an impairment or being regarded as having such an impairment.

disability benefit - 1) Amount payable under a group disability (STD or LTD) plan to a covered employee who meets eligibility criteria typically between 50% and 70% of pre-disability income. Salary continuation plans often provide 100% of pre-disability income prior to eligibility for STD/LTD. 2) A provision added to a life insurance policy providing for a waiver of premium and sometimes payment of monthly income if the insured becomes totally and permanently disabled.

Disability, duration guidelines - Guidelines that describe the duration of different types of disabilities according to diagnosis, symptoms, severity, and occupational factors. Duration guidelines may be used to evaluate disabilities and forecast an expected return-to-work time frame, such as in duration control guidelines.

Disability, earnings - The earnings you receive while you are disabled and working, plus the earnings you could receive if you were working to your maximum capability.

Disability, employer-sponsored plans - A functional limitation that impedes the performance of material duties of an employee's customary work. Disabilities are usually classified as total (permanent total / temporary total) or partial (permanent partial / temporary partial).

disability, full maternity - If an insured employee becomes disabled as a result of a pregnancy or complications, the disability will be covered on the same basis as any other illness.

Disability, individual with - Under the ADA, a person who has a physical or mental impairment that substantially limits one or more of that person's major life activities, has a record of such impairment, or who is regarded as having such an impairment.

Disability, maximum benefit - For disability benefits, the maximum dollar amount an insured will receive while disabled. For health benefits, the total dollar amount the insurer will pay on any given individual.

Disability, maximum benefit duration - The longest period for which employer-sponsored disability benefits will be paid, provided that the employee remains continuously disabled. Typically, the lesser of the number of years until Social Security normal retirement age or the age specified in the plan.

Disability, maximum monthly benefit - The highest dollar amount that an employee who has been disabled will receive each month from the employer's LTD plan.

Disability, pension - An annuity payable from a qualified pension plan to an eligible employee who becomes disabled before normal retirement age. May be paid as a supplement to another employer-sponsored disability benefit plan or as a reduced pension.

Disability, permanent partial - A disability in which some portion of earning power is lost, and the loss is expected to last for the individual's lifetime.

Disability, permanent total - A disability in which all earning power is lost, and the loss is expected to last for the individual's lifetime. In many states, workers' compensation laws specify certain injuries as permanent total disabilities even if the injured person is able to do some work. Compensation may be limited by time or amount, or it may run for life.

Disability, social security - The inability to engage in any substantial gainful activity because of a medically determinable physical or mental impairment that can be expected to result in death or that lasts or can be expected to last for 12 months or more.

Disability, temporary partial - A disability in which some portion of earning power is lost for a period of time, but from which complete recovery is expected. Benefits are generally based on a percentage of the difference between the person's pre-disability wage and what he or she can earn during disability.

Disability, temporary total - A disability in which all earning power is lost for a period of time, but from which complete recovery is expected. Benefits are payable until the individual returns to employment at some level of pre-disability earnings.

Disability, workers' compensation - A physical or psychological condition that occurs in or results from the workplace and that actually or presumptively results in a loss of earning power. Disabilities may be total (permanent total / temporary total) or partial (permanent partial / temporary partial).

Disability Management - Programs that seek to prevent disability, reduce the cost impact of disability, and provide mechanisms to promote maximum functional recovery and return-to-work. Integrated disability management refers to those programs that are implemented across all disability plans (e.g., STD, LTD, WC, and salary continuation) in addition to, increasingly, group health plans.

Disease Management - A coordinated care approach focused on prevention, early identification, and intervention in the chronic disease process. Services are typically provided by employer-sponsored health plans, contracted or "carve out" provider groups, or through the employer's occupational health facility. By controlling factors that determine the early course of a chronic condition, disease management proponents attempt to show that such programs improve individual health status, control medical costs, and reduce the incidence of work limiting disability.

 
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