disability-insurance-decoder

Disability Insurance Decoder Skill

Disability insurance is the coverage most likely to be needed and least likely to be read — and its entire value hides in definitions. "60% of income" can mean 60%, or it can mean 60% of base-only, minus Social Security, minus state benefits, taxed — call it 31%. Whether you're "disabled" at all depends on two words: own occupation or any occupation, and on which date that definition quietly changes. This skill reads the definitions like a claims adjuster will.

What This Skill Produces

• The definition decode: own-occ vs. any-occ (and the switch date), "total" vs. "residual" disability, pre-existing look-back windows
• The real benefit math: stated % → after offsets → after taxes (premium-payer rule) → real monthly number
• Ranked red flags: offset clauses, benefit-period limits for mental-health/musculoskeletal claims, the 24-month own-occ switch
• The reliance checklist — what to confirm with HR or the insurer before treating this coverage as a plan

Required Inputs

Ask for these only if they aren't already provided:

• The policy or plan documents — the certificate/summary plan description; the definitions section is the one that matters. Decode what's provided, list what's missing.
• Their income shape — base vs. bonus/commission split (many plans cover base only — a 40%-commission earner has half the coverage they think).
• Who pays the premium and how — employer-paid pre-tax vs. self-paid post-tax generally flips whether benefits are taxed; flag as jurisdiction/plan-dependent.
• Their occupation — the own-occ vs. any-occ distinction bites hardest for specialized professionals.

Framework: Severity Scale

• 🔴 Can cost you real money — any-occupation definitions (benefits stop if you can do any job you're suited for — quote the exact wording), the own-occ-for-24-months-then-any-occ switch (the industry's quietest clause; find the date), offset stacking (Social Security, state disability, workers' comp all subtracted — the stated 60% is a ceiling, not a floor), base-salary-only coverage for variable-comp earners, 24-month benefit caps on mental-health and self-reported-symptom claims, pre-existing exclusion look-backs that catch recent diagnoses.
• 🟡 Unusual — clarify before relying — long elimination periods vs. their emergency fund (a 180-day wait needs 6 months of runway), residual/partial disability terms (can they work part-time and collect?), portability on leaving the employer (usually none — flag it), cost-of-living riders absent on long benefit periods.
• 🟢 Standard — ordinary elimination periods with adequate runway, true own-occupation definitions, standard exclusions; label the strong parts — a good policy deserves confidence.

Always show the math: stated benefit → minus each quoted offset → tax treatment applied (flagged as depends-on-premium-payer, verify) → the real monthly number vs. their real monthly expenses. The gap between those last two numbers is the finding.

Output Format

Disability Coverage Decode: [policy/plan]

1. The verdict — the real monthly number vs. their expenses, the definition that governs, and the single clause most worth knowing about.

2. Definition decode

| Clause | The policy's words (quoted) | What it means when claiming | Severity |

|---|---|---|---|

3. The benefit math — stated % → offsets → taxes → real number, arithmetic shown, assumptions labeled [verify].

4. 🚩 Red flags, ranked — quoted language, the claim scenario where it bites, the dollar effect.

5. The reliance checklist — what to confirm in writing (own-occ switch date, offset list, tax treatment, portability), and the gap a supplemental individual policy would need to fill — described, not sold.

End the artifact with, verbatim: "This is a plain-language reading, not legal/financial advice — laws vary by jurisdiction; confirm anything load-bearing with a qualified professional."

Quality Checks

• [ ] Own-occ vs. any-occ is quoted verbatim, with any switch date extracted
• [ ] The benefit math runs all the way to a real monthly number vs. real expenses
• [ ] Offsets are listed from the policy text, never assumed absent
• [ ] Tax treatment is flagged as premium-payer-dependent, not asserted
• [ ] Variable-comp earners get the base-only check explicitly
• [ ] The disclaimer line appears verbatim in the artifact

Anti-Patterns

• [ ] Do not invent definitions or offsets that aren't in the documents
• [ ] Do not let the stated percentage stand as the headline — the after-everything number is the headline
• [ ] Do not present tax and benefit-coordination rules as universal — they vary by jurisdiction and plan
• [ ] Do not soften the any-occ finding — for a specialist, it's the difference between covered and not
• [ ] Do not sell products — naming the gap is the job; filling it is the user's shopping trip

Based On

Policyholder-side disability review practice — definition-first reading, offset math, claim-scenario testing.