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Article 7 of 15 in Sample Disability Insurance Policy and Provisions Review |
Disability insurance policy adjustment options |
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Your disability income policy is extremely flexible so you can request a number of adjustments that will change the nature and character of the policy to better suit your needs. All of these changes are subject to the approval of the insurance company,
POLICY ADJUSTMENT OPTIONS
While the policy is in force, you are not Disabled, and no premiums are in default, the Owner may request these policy adjustments:
- Increase or decrease the maximum monthly benefit for the Disability Benefit or Social Security Substitute Benefit sections;
- Lengthen or shorten the Elimination Period on either section;
- Lengthen or shorten the Maximum Benefit Period;
- Add or delete a benefit rider; or
- Any other adjustment we permit based on our then current underwriting rules.
These adjustments will affect this policy’s premiums. |
COMMENT:
Note the conditions required for you to request a policy adjustment. First, the policy must be in force. Second, you cannot be Disabled, which, in this context, means that you are eligible for Disability Benefits even if you are not receiving benefits. This policy says that if you are eligible for Disability Benefits, your request for Policy Adjustments will not be considered. Third, your premiums cannot be in default. The premium is not considered to be in default within the 31-day grace period following the premium due date, but it is in default after the grace period expires. If, for example, your premium is due on June 15 and the grace period expires on July 16 (31 days later), you can request a policy adjustment on July 13, but you cannot request an adjustment on July 18 unless you pay the due premium on or before July 16.
Be aware that all adjustments listed above will affect the policy premium.
POLICY ADJUSTMENT OPTIONS
APPROVAL OF AN ADJUSTMENT
Any requested adjustment is subject to our approval. We require evidence which satisfies us that you are insurable under our then current underwriting rules to:
- Shorten an Elimination Period;
- Lengthen the Maximum Benefit Period;
- Add a benefit rider; or
- Increase the maximum monthly benefit of either the Disability Benefit or Social Security Substitute Benefit section.
We do not require evidence of insurability to:
- engthen an Elimination Period;
- Shorten the Maximum Benefit Period;
- Delete a benefit rider; or
- Decrease the maximum monthly benefit of either the Disability Benefit or Social Security Substitute Benefit section.
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COMMENTS:
The above wording is straightforward. The insurance company retains the right to disapprove any requested adjustment, even one that does not require evidence of insurability. Evidence of insurability is required when an adjustment would increase your benefits.
REQUESTING AN ADJUSTMENT
An adjustment application signed by the Owner must be used to request an adjustment. It must also be signed by you if evidence of insurability is required. An adjustment is effective on the Adjustment Date, subject to our prior approval and payment of the required premium.
ADJUSTMENT DATE
The Adjustment Date will be the Monthly Date next following the date we approve the request for adjustment.
EFFECT OF AN ADJUSTMENT
The adjusted benefits apply to a Disability from a Sickness which first manifests itself or an injury which occurs on or after the Adjustment Date. The adjusted benefits will not apply to a Recurring Disability which is a continuation of a Continuous Disability which started before the Adjustment Date.
DATA PAGES
Any adjustment will change the information on this policy’s Data Pages. We have the right to require that the policy be sent to us so we can replace these pages with new ones reflecting the adjustments. |
COMMENTS:
Note a special application is needed for adjustment requests. The Owner, who is the Insured unless the original policy application names someone else as the Owner, must sign the application.
Adjusted benefits apply only to a sickness that first manifests itself or an injury that occurs on or after the Adjustment Date. Although the courts are not in total agreement, generally a sickness is manifest when a medical professional can diagnose the ailment with reasonable certainty from a distinct symptom or condition. The insured does not need to be disabled from the condition, but courts generally do not consider that a condition has manifested itself if it has been has been present without noticeable symptoms. |
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