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My Long-Term Disability Insurance Quote Worksheet

Insurance Company 1
Insurance Company Name:
Company Phone Number:
Company Address:
Contact:
Cost of yearly premium:
How long selling LTD?:
How much LTD do you have in force?:
How many times has the rate increased for those who already own a policy?
 
In how many states are you currently selling LTD?
 
Is your company on the block to be sold?
  Yes    No
How are you rated?:
What percentage of income will the policy pay?
 
How long is my elimination or waiting period?
 
Until what age will the policy pay?
 
Do you cover me if I am disabled because of illness as well as in an accident?
  Yes    No
What if I can work only part-time because of my disability?
 
Is it "owner's OCC" or "any OCC"?
  Owners OCC    Any OCC



Insurance Company 2
Insurance Company Name:
Company Phone Number:
Company Address:
Contact:
Cost of yearly premium:
How long selling LTD?:
How much LTD do you have in force?:
How many times has the rate increased for those who already own a policy?
 
In how many states are you currently selling LTD?
 
Is your company on the block to be sold?
  Yes    No
How are you rated?:
What percentage of income will the policy pay?
 
How long is my elimination or waiting period?
 
Until what age will the policy pay?
 
Do you cover me if I am disabled because of illness as well as in an accident?
  Yes    No
What if I can work only part-time because of my disability?
 
Is it "owner's OCC" or "any OCC"?
  Owners OCC    Any OCC



Insurance Company 3
Insurance Company Name:
Company Phone Number:
Company Address:
Contact:
Cost of yearly premium:
How long selling LTD?:
How much LTD do you have in force?:
How many times has the rate increased for those who already own a policy?
 
In how many states are you currently selling LTD?
 
Is your company on the block to be sold?
  Yes    No
How are you rated?:
What percentage of income will the policy pay?
 
How long is my elimination or waiting period?
 
Until what age will the policy pay?
 
Do you cover me if I am disabled because of illness as well as in an accident?
  Yes    No
What if I can work only part-time because of my disability?
 
Is it "owner's OCC" or "any OCC"?
  Owners OCC    Any OCC