Insurance companies often define disability in terms that can be confusing. It's not enough to simply be disabled; the insurance company will attempt to determine if you are temporarily or permanently disabled, and then whether the disability is total or partial. It's essential to understand how disability is defined as it determines the benefits you will receive.
You are considered totally disabled if you cannot work at all, whether it is for a long period of time or temporarily. Still, long-term disability insurance companies can define total disability in a few ways.
Most disability policies presume that certain conditions result in a total disability. These conditions include loss of speech, loss of eyesight in both eyes, loss of hearing in both ears, or the loss of use of both hands or both feet (or one hand and one foot).
The most important distinction to understand is that between "own occupation" and "any occupation" coverage. If you have an "own occupation" policy, total disability will be defined as an inability to perform the duties of your specific occupation. This means you can possibly work in another job and still receive disability benefits. This type of policy has broad coverage and is less common. "Any occupation" coverage is the most common type of policy and it defines total disability as an inability to perform the duties of any occupation. To fit this definition, you must be unable to work in any gainful occupation for which you are suited based on work experience and education, not just your occupation.
Partial and Residual Disability
A disability may also be considered residual or partial. These definitions are similar, but slightly different. Residual disability refers to an inability to perform at least one duty of your occupation and the loss of a large share of your pre-disability income. This type of policy pays benefits based on the amount of income you have lost due to the disability and it's usually required that you have lost at least 20%.
Partial disability coverage is similar as it also pays if you are unable to perform some duties of your job. The difference is loss of income is not considered with partial disability coverage. Instead, you are usually paid 50% of the benefit you would earn if you were found totally disabled. This type of coverage usually has a benefit period of just 6-12 months.
If you have been injured and you need assistance filing a disability insurance claim -- or your claim has been denied -- it's important to consult with an experienced disability attorney as soon as possible. Our disability insurance lawyers at Dabdoub Law Firm focus solely on disability insurance claims and lawsuits to represent clients who have been hurt and are unable to work.