Insurance Licensing New York Life, Accident and Health Insurance Agent/Broker Examination Series 17-55 NY-Life-Accident-and-Health Question # 8 Topic 1 Discussion
Insurance Licensing New York Life, Accident and Health Insurance Agent/Broker Examination Series 17-55 NY-Life-Accident-and-Health Question # 8 Topic 1 Discussion
A policyowner suffers an injury that renders him incapable of performing one or more important job duties. Any decrease in income resulting from his injury would make him eligible for benefits under which provision?
This situation describes a disability that does not completely prevent the insured from working, but does reduce the insured’s ability to perform significant or “material” duties of the occupation , resulting in a loss of income . Under accident and health disability income concepts, that is the definition of partial disability , which pays benefits when the insured can work in a limited capacity (or perform only some duties) and suffers measurable earnings reduction. “Nondisabling injury” is typically a limited benefit that applies when an injury does not create disability as defined by the policy (often paying a small scheduled amount for medical/accidental injuries without inability to work). “Presumptive disability” refers to severe, specified losses (such as loss of sight, hearing, speech, or limbs) that trigger total disability benefits regardless of work capacity. “Flat amount disability” does not match the key clue in the question—eligibility based on decreased income —because partial disability provisions specifically tie benefits to reduced ability to work and corresponding earnings loss.
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