Total Disability and Partial Disability- Explained

Many disability insurance policies contain a provision for partial (residual) disability benefits if you are unable to work full time, but can perform some of the material duties of your occupation. The clauses differ from policy to policy. Some will provide a benefit if you are unable to perform your occupational duties for your normal work hours. For example, if due to your sickness or illness you can only work in the morning because you become too fatigued in the afternoon, and your income is reduced at least 20%, you may qualify. Other policies provide benefits even if you do not have a change in your work hours, as long as you are unable to perform all of the material and substantial duties of your occupation.

The benefits that are provided vary from policy to policy; and usually are derived from a formula contained in the policy provision. Some policies guarantee a monthly payment of no less than 50% of the benefit for the first six months of your disability regardless of your exact income loss.

The definition of total disability typically provides that you are unable to do the important duties of your occupation or the material and substantial duties of your occupation. A constant problem arises for professionals such as doctors who are unable to perform surgery due an injury or sickness but can still operate an office based practice. Their income may actually increase as a result of being able to charge more for their office services. Are they totally disabled or partially disabled? Many insurers assert that this is a partial claim, and you are not entitled to any benefits or only a portion of your benefit.

Another problems arises if the professional reduces his occupational duties due to his disability before filing , such as reducing night call and stopping surgery. By the time you go on disability you may have restructured your occupational duties and redefined you occupation. This is a one of many hot topics affecting our clients who are doctors and lawyers and other professionals.

Bonny G. Rafel LLC and her staff can analyze your claim and provide direction before you file for disability or during the process.