627.4233 Total disability defined. - Florida Statutes

627.4233 Total disability defined.

   (1) If an individual or group policy of disability income insurance provides for the waiver of premiums or payment of claims upon total disability:

   (a) The policy must, at a minimum, provide that for the first 12 months of the disability, a person is totally disabled if the person is unable to perform the material and substantial duties of the person’s regular occupation, or must include a provision at least as favorable to the insured.

   (b) The policy may provide that after the first 12 months of disability as described in paragraph (a), the insurer may predicate the continuance of benefits on the person’s ability to perform any work or occupation for which the person is reasonably qualified or trained.

   (2) If an individual or group policy of life insurance provides for the waiver of premiums or payment of claims upon total disability, the definition of total disability may not be more restrictive than the person’s inability to perform any work or occupation for which the person is reasonably qualified or trained.

   (3) If an individual or group policy of medical expense insurance provides for extension of benefits for persons who are totally disabled on the date their insurance terminates, the definition of totally disabled may not be more restrictive than:

   (a) For an employee, the person’s inability to perform any work or occupation for which the person is reasonably qualified or trained; or

   (b) For a dependent, the person’s inability to engage in most normal activities of a person of like age and sex in good health.

History. s. 119, ch. 92-33; s. 1, ch. 95-364.