You bought disability insurance to protect your income in case of injury or sickness. At claim time, the assumption is that your insurance will be there. In September 2019, the OMA made material changes to its group disability insurance policy 17489 and we want to make sure you are aware of these changes.
Specifically the definition of total and partial disability insurance has significantly been downgraded. There are 3 material changes to the OMA group disability insurance policy definitions:
- Partial disability definition has been updated and now includes a clause that reverts to an any occupation definition of disability after 24 months…“After the partial disability benefit has been paid for 24 months, then partial disability means the insured is under a physician’s care, not totally disabled and engaged in any gainful occupation and unable to work for 20 or more hours per week. Gainful employment means any occupation for which the insured is reasonably qualified by education, training or experience.”
Source: OMA disability contract 17849 revised Sept 2019 – Page 5 - Total disability definition has been updated and reverts to an any occupation definition of disability after 24 months. … “After the total disability benefit has been paid for 24 months, then total disability means the insured is under a physician’s care and due to sickness or injury is unable to perform any gainful occupation which the insured is or may be reasonable qualified by training or experience.”
Source: OMA disability contract 17849 revised Sept 2019 – Page 6 - Pre-existing condition amendment for insurance obtained without proof of good health has been updated to include an exclusion for any sickness or injury sustained before the coverage was inforce.… “no benefits are payable for any disability cause by injury sustained or sickness which first manifests itself before the coverage is inforce”
Source: OMA disability contract 17849 revised Sept 2019 – Page 12
Can the OMA or its insurer change the insurance definitions or rates?
YES. A group insurance policy gives the insurer and/or the group the option to change rates and definitions at their discretion. In 2018, the OMA cancelled the rebate on their disability insurance and now they have made material changes to the definitions of disability.
Is there an ethical issue with these changes?
NO. The definition of group insurance is that the group (OMA) and/or its insurer can change the policy definitions and rates at their discretion. This is the risk that someone takes when purchasing a group disability insurance plan, you lose control of your policy.
How does this compare to an individual disability insurance policy?
Individual disability insurance plans do not have these limitations. With an individual insurance plan, you have locked in rates, policy provisions and guarantees on your definition of disability. Only you can change an individual insurance policy. If you get sick or injured, you don’t have to worry about your claim being paid. As doctors are now learning, the same level of guarantees and peace of mind cannot be said with group insurance.
NEXT STEPS
If you have OMA group disability insurance you may want to consider transferring it to an individual insurance plan that you own and control. We are here to assist. As an Physician, you will get up to a 25% discount and preferred underwriting through our office.
Feel free to email info@levinefinancialgroup or call 416-222-1311
Elliott Levine is the President of Levine Financial Group in Toronto
We Save Physicians Money on their Insurance
416-222-1311 I info@levinefinancialgroup.com