How disability insurance helps to bridge the income gap when you can’t work
When a serious illness or injury keeps you from working, disability insurance can help replace part of your income. But whether you qualify for benefits and how much you receive often depends on details buried in the fine print. Terms like “elimination period,” “own occupation,” and “residual benefits” can shape how your coverage works, what it costs, and how much protection it offers.
Key Points
- Disability insurance pays a portion of your income if an illness or injury prevents you from working.
- Policies are either short term or long term, depending on how long benefits last.
- Terms like “own occupation,” “elimination period,” and “residual benefits” determine how coverage works and how much income it replaces.
What is disability insurance?
Disability insurance replaces a portion of your income when you can’t work because of an illness or injury. Policies may be provided through your employer, purchased individually, or—depending on where you live—offered through a state-run program. California, Hawaii, New Jersey, New York, and Rhode Island require employers to participate in short-term disability programs that provide partial wage replacement. Puerto Rico has a similar program.
These forms of disability insurance are separate from Social Security Disability Insurance (SSDI), a federal program with strict eligibility rules and limited benefits for long-term conditions, and from workers’ compensation, which covers only job-related injuries or illnesses.
How does disability insurance work?
As with other insurance policies, you pay a premium to an insurer, and it promises to pay benefits when specific conditions are met. Disability insurance typically covers 40% to 80% of your income if you’re unable to work due to an illness or injury.
It’s not so simple, though. Whether you receive benefits depends on several factors.
Policy features that affect coverage and cost
Short-term vs. long-term disability insurance. Short-term disability insurance provides benefits for injuries or illnesses lasting from several weeks up to 12 months, depending on the policy. Payments are made weekly until you can return to work. Long-term disability insurance covers conditions that prevent you from returning to work for six months or longer, potentially extending until retirement. This coverage is intended for more severe or permanent disabilities.
Own occupation vs. any occupation. Individual long-term disability insurance policies often let you choose between two types of coverage: own occupation and any occupation. They differ in how disability is defined and when benefits are paid:
- Own-occupation coverage pays benefits if you cannot perform the duties of your specific occupation, even if you’re able to work in a different field. These policies typically carry higher premiums.
- Any-occupation coverage pays benefits if you’re unable to work in any occupation for which you’re reasonably qualified based on your education, training, or experience. You may be ineligible for benefits if you can perform another job, even in a different field or at a lower salary. It’s usually harder to qualify for benefits with any-occupation coverage, although policies with this definition often cost less.
Elimination period. The elimination period, also called the waiting period, is the time between when your injury or illness begins and when you start receiving disability benefits. When you buy short-term disability coverage, you typically choose an elimination period—often 7, 14, 21, or 28 days. For example, if you choose a 14-day elimination period, your benefits won’t begin until you’ve been unable to work for 14 days. During that time, you’re responsible for your living expenses.
Long-term disability insurance typically has longer elimination periods—30, 60, 90, or 180 days. You’ll need to cover expenses yourself during that period—typically through savings or an emergency fund—or have a short-term disability policy that bridges the gap between short- and long-term benefits.
Residual benefits. If you’re injured and able to return to work but not full-time—or if your duties change and your income drops—a residual benefits rider can help cover the loss. This add-on pays partial benefits based on the income lost because of reduced capacity. It raises your premiums, but can offer peace of mind. Policies typically specify a minimum loss to your income, often 15% or 20%, to qualify for residual benefits.
Waiver of premium. A waiver of premium rider keeps your disability insurance policy active if you can’t make payments because of a serious injury or illness. It can protect you during the elimination period and help ensure your coverage stays in force even if you’re temporarily unable to pay. Without this rider, missing a payment could give the insurer reason to deny your disability claim.
Renewability. A guaranteed renewable policy lets you keep your coverage without a new medical exam each year or at the end of a multiyear term. The insurer can raise premiums for your class of policyholders, but it can’t cancel your coverage as long as you pay on time.
Noncancelable. A noncancelable rider locks in your policy terms—including your premium—until a specified age, often 65. The insurer can’t change your coverage or rates, regardless of changes to your health or age. Many policies include both noncancelability and guaranteed renewability.
Is disability insurance worth it?
Losing income because of illness or injury can strain your budget, especially if you’re out of work longer than expected. Disability insurance can help, but whether it’s worth it depends on your financial situation, including the likelihood you’ll need it and whether you already have coverage through your employer.
Disability insurance typically pays benefits for injuries and illnesses unrelated to your job, such as accidents, serious health conditions, medical recovery, or complications during pregnancy. It generally doesn’t cover situations involving illegal activity or self-harm.
Taxes and disability benefits: What to know
For employees, whether your disability insurance benefits are taxed depends on who pays the premiums and how:
- If your employer pays the full cost, your benefits are considered taxable income.
- If you pay the full premium with after-tax dollars—either for an individual policy or through payroll deductions—your benefits are not taxed.
- If the cost is shared, only the portion tied to your employer’s contribution is taxable.
Self-employed individuals are subject to different rules. For example, if you deduct premiums as a business expense, any benefits received may be taxable income.
If you’re mostly concerned about short-term medical leave, an emergency fund that covers at least a few months of expenses might be a better option than paying for short-term disability insurance. But if you’re looking for protection against long-term or partial disability, a policy can help preserve your savings and provide consistent income while you’re unable to work.
If you already have coverage through your employer, weigh whether it’s enough to meet your needs. Group plans often limit how much or how long they’ll pay, so adding an individual policy may make financial sense—especially if a long-term disability would strain your savings.
How much does disability insurance cost?
Premiums typically run about 1% to 3% of your income. Your actual cost depends on factors like your health, job duties, elimination period, benefit amount, and whether you choose own-occupation or any-occupation coverage. Add-ons like residual benefits, guaranteed renewability, and provisions for noncancelability can also raise the price.
The bottom line
Nobody plans to get sick or injured, but it happens—and when it does, it may mean missing weeks or even months of work. Disability insurance can help replace some of your lost income during that time, but whether it makes sense depends on your financial situation. Think about what resources you’d rely on if you couldn’t work for a while, whether it’s your savings, coverage by your employer, or support from family or friends. Then consider whether a policy would offer peace of mind or fill a gap you couldn’t easily cover using your own resources.
References
- Long-Term Disability Insurance Benefits | patientadvocate.org
- Short-Term Disabilty Insurance Benefits | patientadvocate.org