Does life insurance cover permanent total disability or only absolute disability?

Question

José Manuel Alburquerque · Accepted Answer

It depends on what the policy says. Many, especially those linked to mortgages, only cover permanent absolute disability (“incapacidad permanente absoluta”), which prevents any work. Others also include permanent total disability (“incapacidad permanente total”), which prevents you from doing your usual work but allows other work. If the policy only refers to absolute disability and you are awarded total disability, in principle you are not covered. But if your actual condition fits the policy's definition, or the definition is unclear, there may be scope to claim even if Spanish social security has awarded you a different degree. The types of disability Total. It prevents you from doing your usual occupation, but not others. Absolute. It prevents you from doing any occupation or trade. Severe disability (“gran invalidez”). In addition, you need another person's help with the most basic things. What to look for in the policy What cover it includes. Sometimes total disability is included as separate cover, with its own sum insured and its own premium. If it is included, check which occupation is stated in the policy, because that is usually the one that counts. How it defines each type of disability. If it simply uses the social security terms, they have the meaning they have in social security law. If it has its own definition, that is the one that counts. If the definition is stricter than the social security one, for example because it requires you to be unable to look after yourself or to do any activity at all, the courts tend to treat it as a clause limiting the rights of the insured, which must be highlighted and signed separately. And if it is unclear, it is interpreted in favour of the insured. If you are awarded total disability and the policy requires absolute disability Check whether your medical condition fits the policy's definition, which may not be the same as the social security one. If your condition gets worse, you can ask the “INSS”, Spain's National Social Security Institute, to review the degree from the date set in the decision itself and, if you are awarded absolute disability, claim then. In the meantime, keep paying for the insurance. If absolute disability comes when the policy is no longer in force, the insurer will dispute the date of the insured event.