Questions & answers · Disability insurance
Who pays for an illness or injury — will my disability insurance cover it?
Disability insuranceWho paysTexasChecked Nov 6, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: Texas Insurance Code · Chapter 1201 · § 1201.055(a) (Exceptions and Reductions of Indemnity) View original ↗
In short
- Your own policy, not this law, sets what counts as a disability.
- Too much cover for your pay triggers a cut to match.
- These sources do not give your benefit amount — only your policy does.
What this means
Your own policy says what counts as a covered "disability." Texas law makes the policy state every exception and cut it uses [1].
Some policies have an earnings clause [2]. It kicks in when your total cover is bigger than your pay would allow [2]. Texas law lets the insurer scale the benefit back to match [2]. It also makes the insurer refund the extra premium you paid [2].
Your next step
Read your own policy first. Find how it defines "total disability" and "partial disability," and read its list of exclusions. The sources above set no filing deadline for a coverage question like this. Your policy's own notice and proof-of-loss clauses do set one, so read those too.
Check it yourself
Open your policy. Look for a clause named "Relation of Earnings to Insurance." If it is there, read how it counts your pay. Compare that with what you earned when you stopped work. Then list any other cover that pays for lost time. The clause counts those too.
Where this comes from (2)
[1] Texas Insurance Code · Chapter 1201 · § 1201.055(a) (Exceptions and Reductions of Indemnity) · checked 2026-11-06
An individual accident and health insurance policy must state each exception to or reduction of indemnity for the policy.
[2] Texas Insurance Code · Chapter 1201 · § 1201.222(a) (Policy Provision: Relation of Earnings to Insurance) · checked 2026-11-06
Relation of Earnings to Insurance: If the total monthly amount of loss of time benefits promised for the same loss under all valid loss of time coverage on the insured, regardless of whether the benefits are payable on a weekly or monthly basis, exceeds the amount of monthly earnings of the insured at the time the insured's disability began or the insured's average amount of monthly earnings for the period of two yea…
How we found this
We matched your question to 2 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.
What we don’t know yet
Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.
Every answer is checked against the official rule it quotes.
Information only — not legal advice. Your plan, insurer or agency decides.
This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.
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