How Do Partial Disability Benefits Work?

Some disability policies allow for recovery of partial disability benefits if you are still able to work on a limited basis. In newer disability policies, this feature is typically added as a rider that you must choose to add to the base policy. If your policy does not have a partial disability or residual disability rider, it may only cover total disability.

What is the Difference Between Total Disability and Partial Disability?

Individual policies sold to physicians and dentists typically define “total disability” as the inability to perform the material and substantial duties of your occupation.

In contrast, partial disability benefits are designed to supplement your income if your ability to work is limited by a sickness or injury. After the elimination period has been satisfied, benefits are due for each month that you can prove both that you have (1) suffered a loss and (2) that the loss was due to sickness or injury. This second requirement is sometimes referred to as establishing a “demonstrated relationship” between the loss and the disability.

How Do I Collect Partial Benefits?

Most older disability policies require a threshold loss in income in order to qualify for partial benefits, typically around 15 to 20%. New policies can define loss in other ways, including losses in hours or losses in the ability to perform a certain percentage of your material duties.

When reviewing your policy, it is also important to pay attention to whether the requirements for collecting change over time. For example, many partial disability riders outline different rules for collecting during the first 6 or 12 months of disability, versus the remaining months of disability.

How Do I Know if I Have a Partial or Total Claim?

Because each policy defines partial disability differently, the first step is to locate the definitions for total disability and partial disability.

Once you know your policy’s requirements, the next step is evaluating factors such as the nature of your condition, the extent of your limitations, and whether you meet your policy’s loss thresholds. Another important consideration is whether you are putting your own health or patients’ health in jeopardy by continuing to practice.

In some instances—such as claims involving slowly progressive conditions like cervical radiculopathy or an essential tremor—it can be difficult to evaluate whether you are partially or totally disabled and/or whether a partial disability has progressed to the point where it is now totally disabling.

As each claim is different, there is no one-size fits all answer to this question, and whether you are partially or totally disabled will come down the particular facts of your disability claim and your particular policies’ requirements. If you have questions about your claim or potential claim, please feel free to contact our attorneys directly to set up a consult.


Search Our Site