The Edge Series: What Does "Actively at Work" Mean?
The lawyers in our firm are focused on helping people with disability policies and ERISA claims. We want to give you the edge in understanding your policy. Today, we want to help you understand what the term "actively at work" means in your disability policy.
Not only is this provision often found in disability policies, but it is also often found in health insurance policies. It is used to exclude coverage from an employee who is not working full-time on the date the claim arises.
What is the definition of "Actively at Work?"
To meet the definition of "Actively at Work," you must be engaged in a full-time working position when the disability claim is asserted. If not, you might not be covered. That does not necessarily mean that you must have 30 to 40 hours per week if a claim arises. It is usually enough if your position requires you to work full-time, and you are engaged in that position before the claim arises. It does not mean if you go on vacation you lose your coverage. As long as you are still engaged in your full-time position, even if permitted customary time off, your coverage should still be in place.
How do insurance companies use the "Actively at Work" definition to deny claims?
This provision protects insurance companies from fraudulent or unfair circumstances. For example, if someone is no longer working for their employer but is left on their insurance, that is contrary to this provision. Also, if a very sick person who can clearly not work the full-time position is put on the insurance but never actually works full time, again, coverage may not be provided.
On the other hand, if the employee just started a full-time job with a disability benefit in place, that meets the definition. That is true even if the disability arises within your first week of coverage. The line is drawn with the "Actively at Work" definition.