In a long-term disability claim, “maximum capacity” typically refers to the highest level of physical or mental functioning that an insured is capable of achieving based on medical evidence, vocational assessments, and other relevant factors.
The insurance company will typically evaluate the insured’s ability to perform the material duties of their occupation based on their maximum capacity. This assessment may involve reviewing the insured’s medical records, consulting with healthcare providers and vocational experts, and conducting functional capacity evaluations or other assessments to determine the insured’s functional limitations and restrictions.
If the insured is unable to perform the material duties of their occupation at their maximum capacity due to a covered disability, they may be eligible to receive long-term disability benefits. However, the policy language will define what qualifies as a covered disability and what specific requirements must be met to receive benefits.
It’s important to carefully review the terms and conditions of an individual disability insurance policy or group long-term disability insurance policy to understand the maximum capacity requirements, as well as any exclusions or limitations that may apply.