A benefit trigger is the inability to perform the specified activities of daily living without the aid of another person. The lack of being able to perform these activities causes or “triggers” the monetary benefits of a disability insurance policy to begin. If you are insured with a disability policy and you find that you are unable to perform the activities of daily living, you may qualify for your disability benefits as stated in your policy.
These activities of daily living are several functions that all people should be able to perform daily without aid or assistance. These activities include the following:
– Bathing: This includes regular hygienic care of yourself, meaning bathing or showering.
– Dressing: You should be able to dress and undress yourself on a daily basis.
– Eating: If you have trouble feeding yourself, this may become a benefit trigger.
– Toileting: This includes the preparations taken to use the toilet and the actual use of the toilet.
– Continence: This refers to the inability to control bladder or bowel movements in inappropriate places.
If you are unable to perform these activities of daily living on your own and without assistance, then they become benefit triggers. There may be other provisions outlined in your specific policy that may also help determine when you are able to begin receiving benefits. These additional provisions are not meant to replace or restrict the above requirements.
If you require the hands-on or supervisory assistance of another person to help you in your daily functions, you will be eligible for benefit payment. Depending on your policy, eligibility for benefit payment may mean that there is a deficiency in the performance of only three or fewer activities of daily living. This means that you may still be able to perform some of the activities, but if you are unable to perform as few as three, then your benefits may be triggered.
A second benefit trigger that may qualify you to receive benefits is cognitive impairment. Cognitive impairment may or may not hinder the activities of daily living. If you have a problem performing these daily functions due to the presence of cognitive impairment, this can cause the benefit triggers to activate your insurance policy. If your cognitive impairment causes you to be supervised to ensure that you don’t cause harm to yourself or to other people, it also becomes a benefit trigger.
Check your specific disability insurance policy to see how the benefit triggers work and if they are defined in your policy. If you are currently looking for disability insurance, be sure that these benefit triggers are included in the policy. It is often defined as ADL Standby Assistance, and if you don’t have it, you may find that it is harder to qualify for benefits when you become disabled and you need to claim them.
In order to receive benefits, assessments will be done on your daily living and cognitive impairment, if any, by licensed and certified professionals, such as physicians, nurses, or social workers.
There may be a length of time that is required for you to wait to see if your disability still lingers. The daily activities may not become benefit triggers until you cannot perform them for as long as 90 days. Check your personal insurance policy to see if there is a waiting period and how long it lasts.