Chapter 12/2 Accident and Sickness Definitions

A permanent partial disability is covered by which of the following definitions for disability?

Residual disability covers permanent partial disability. The correct answer is: Residual

While working in the lumber yard, five 2x4's fall on Peter's foot, breaking four toes. Peter cannot work for one month while he is recuperating. When Peter gets back to work, two months after the incident, he breaks his toes again. Which definition of disability fits this scenario?

A recurrent disability is a disabling injury that occurs as the result of a prior disabling injury. The correct answer is: Recurrent disability

While at work, a heavy box falls on Emily's foot breaking three of her toes. She is unable to work for one month. Two months later while working, she breaks her toes again. Which of the following definitions of disability applies to Emily's situation?

A recurrent disability is a disabling injury that occurs as the result of a prior disabling injury. The correct answer is: Recurrent disability

Recurrent disability is:

A recurrent disability provision is a time period specified in the policy, during which the recurrence of a disabling condition is considered an extension of a prior disability. This provision prevents the insured from needing to fulfill another elimination period for a disability that has simply reappeared. The recurrent disability provision is usually a period of 90 days, but in some policies, is six months. The correct answer is: A time period specified in the policy during which the recurrence of a disabling condition is considered an extension of a prior disability

What type of disability is characterized as something the insured is never expected to recover from, causing the insured to be unable to work permanently?

An insured is never expected to recover from a permanent disability, causing the insured to be unable to work permanently. Examples of permanent disability include loss of limbs and total blindness. The correct answer is: Permanent disability

Which of the following is not described in disability income policy benefit provisions?

Disabilities are defined in the definitions section of a disability income policy. The correct answer is: Definition of disability

All of the following are false regarding the elimination period in a disability income policy, EXCEPT:

Longer elimination periods have lower premiums because the insured is going without benefits for a longer period of time. The correct answer is: Longer elimination periods have lower policy premiums.

What is the primary difference between partial and residual disability?

Partial and residual disability both state that the insured is unable to perform some of their work duties, and the amount of the benefit is 50% of the total disability benefit. The primary difference is the length of the benefit period, which is usually limited to six months in a partial disability benefit. The correct answer is: The length of the benefit period is longer with residual disability

All of the following are true statements regarding partial disability, EXCEPT:

Partial disability benefits can be paid for accidental injury or sickness. The correct answer is: Partial disability benefits are only paid for sickness.

Which of the following is false regarding the definition of partial disability?

Partial disability benefits can be paid for accidental injury or sickness. The correct answer is: Partial disability benefits are only paid for sickness.

Partial disability is:

Partial disability is the inability of an individual to perform one or more work duties in their own occupation, or the inability to work full-time. The individual's income must be reduced as a result of the partial disability. A partial disability benefit covers loss of income resulting from a person's inability to perform their work duties to the fullest. Partial disability benefits are usually half of the total disability benefits and are paid for up to six months. The correct answer is: The inability of an individual to perform one or more work duties in their own occupation, or they cannot work full-time

Presumptive disability is:

Presumptive disability is a condition in a disability income policy that permits the insured to be automatically eligible for total disability income benefits regardless of their ability to work. Examples of presumptive disability include loss of vision in both eyes, dismemberment or loss of use in any two limbs or complete loss of hearing or speech. The correct answer is: A condition in a disability income policy that permits the insured to be automatically eligible for total disability income benefits regardless of their ability to work

Residual disability is:

Residual disability is when the insured has a total disability, returns to work but can only perform some of the duties they could perform prior to the disability. The correct answer is: When the insured has a total disability, returns to work, but can only perform some of the duties they could perform prior to the disability

All of the following are false regarding disability income policy benefit periods, EXCEPT:

Shorter benefit periods have lower premiums, and longer benefit periods have higher premiums. The correct answer is: Longer benefit periods have higher premiums.

A health insurance policy containing which of the following provisions is the cheapest?

The any occupation definition is more restrictive and consequently, less expensive than the own occupation definition of disability. Policies with longer elimination periods are less expensive. The correct answer is: Any occupation policy that has a 180-day elimination period

Which of the following policies is the least expensive?

The any occupation definition is more restrictive and consequently, less expensive than the own occupation definition of disability. Policies with longer elimination periods are less expensive. The correct answer is: Any occupation policy that has a 180-day elimination period

The ____________ is the period of time disability income benefits will be paid to the insured after the elimination period is fulfilled.

The benefit period is the period of time disability income benefits will be paid to the insured after the elimination period is fulfilled. Benefit periods may be one year, two years, five years, or until the insured reaches the age of 65 (retirement age). Longer benefit periods require higher premium payments. The correct answer is: Benefit period

All of the following are true regarding the elimination period in disability income policies, EXCEPT:

The elimination period is a time deductible specifying a period of time before benefits will begin once the insured becomes disabled. The elimination period is considered a time deductible instead of a dollar deductible because it is a period of time the insured must be disabled before the policy begins to pay benefits. Elimination periods range from 30 to 180 days or more. Policies with longer elimination periods have lower premiums because the insurer is not paying benefits for as long a period than if benefits had begun immediately. The purpose of the elimination period is to prevent the insurer from paying short-term disabilities. The correct answer is: The elimination period occurs once during the policy period.

The time deductible in disability income policies is formally called a/an:

The elimination period is a time deductible, specifying a period of time before benefits will begin, once the insured becomes disabled. The elimination period is considered a time deductible instead of a dollar deductible because it is a period of time the insured must be disabled before the policy begins to pay benefits. The correct answer is: Elimination period

How does an elimination period work in disability income policies?

The elimination period is a time deductible, starting on the date of disability for a certain number of days, until benefits are paid. The elimination period must be satisfied for each disability. The correct answer is: For each disability, the insured must satisfy an elimination period.

All of the following would be paid under a presumptive disability benefit, EXCEPT:

The presumptive disability benefit will pay total disability benefits for the following: loss of vision in both eyes; dismemberment or loss of use in any two limbs; or complete loss of hearing or speech. The correct answer is: Partial hearing loss

Which is not covered under a presumptive disability benefit?

The presumptive disability benefit will pay total disability benefits for the following: loss of vision in both eyes; dismemberment or loss of use in any two limbs; or complete loss of hearing or speech. The correct answer is: Partial hearing loss

What is the purpose of the elimination period in disability income policies?

The purpose of the elimination period is to prevent the insurer from paying short-term disabilities. The correct answer is: To prevent payment of short-term disabilities

With the __________ definition of accident, the reason the accident occurred must be unintentional and unexpected.

The reason the accident occurred must be unintentional and unexpected. The accidental means definition of an accidental injury is more restrictive than the accidental bodily injury definition. The correct answer is: Accidental means

All of the following are not characteristics of the recurrent disability provision, EXCEPT:

The recurrent disability provision is intended to waive the elimination period for a disabling condition that is considered a recurrence of a prior disability. The correct answer is: Considers a disabling condition an extension of a prior disability

The recurrent disability provision:

The recurrent disability provision prevents the insured from needing to fulfill another elimination period for a disability that occurs as the result of a prior disabling injury. The correct answer is: Waives the elimination period

What is the primary purpose of the recurrent disability provision?

The recurrent disability provision prevents the insured from needing to fulfill another elimination period for a disability that occurs as the result of a prior disabling injury. The correct answer is: Waives the elimination period

Annie is permanently partially disabled due to scoliosis, but can still work part-time. Which definition of disability would provide the greatest benefit to Annie?

The residual disability benefit provides the longest benefit period for a permanent partial disability. The correct answer is: Residual disability

Eric is permanently disabled, but can still work part-time. Which definition of disability would provide Eric the most benefit?

The residual disability benefit provides the longest benefit period for a permanent partial disability. The correct answer is: Residual disability

Maria is moving boxes into her new apartment and strains her back, causing a disability. Her disability income policy will not pay benefits because her injury was not unforeseen. Maria's policy uses:

With the accidental means definition of injury, the accident must be unforeseen and the reason the accident occurred must be unexpected. The insurer considered Maria's accident to be an expected occurrence and, therefore, declined benefits. The correct answer is: The accidental means definition of injury