Long Term disability insurance is intended to provide income protection to individuals or employees that become ill and unable perform all or any of the duties of his or her regular occupation.
When litigating disability insurance claims, your lawyer must clearly determine the amount of disability benefits that you the claimant, are entitled to. This amount depends on the provisions set out in your insurance policy. Some claimants may be entitled to full coverage, while others only qualify for “partial” or “residual” benefits. There are many different types of policies and coverage can vary. Your policy may provide for partial or residual benefits. Your lawyer can help you with this determination.
Not all disability plans or policies are the same. Many policies require the claimant to be “totally disabled” before they can make a claim for full benefits. But what if you can only work a few hours a day, and your employer is unable to accommodate these changes in your ability? Does your policy provide for partial benefits? Or does this mean you meet the requirements under the definition of “Total Disability?”
Both short term and long term disability plans have qualifying time periods called elimination periods in which the claimant must be unable to work before they are eligible for benefit coverage. Waiting periods for short term disability coverage are commonly significantly shorter than they are for long term disability plans. Elimination periods for long term disability can range from a few months up to a year. In general, lower the policy cost, longer the elimination period.
Partial Benefits and Residual Benefits. How Are These Definitions of Disability Similar? How Are They Different?
The underwriting of each disability policy is different. In general terms, an insured who qualifies for total disability benefit and is able to work in a reduced capacity may be eligible to partial benefit coverage. The claimant’s pre-disability earnings and the amount of income lost will determine the amount of benefits. In most policies, loss of income must also meet a policy defined percentage before the employee is eligible for benefits.
Partial Disability Benefits
In many insurance policies partial benefits may be payable to those disability claimants who are still able to perform some of there job and work related duties.
- Claimant is unable to perform any of the duties of his or her own occupation
- As determined in the policy, the claimant has a qualified percentage of loss in monthly earnings due to the same sickness or injury
- “Partial” definition of disability. In some policies – the claimant has to be totally disabled during the elimination period.
- The ways in which benefits are calculated for partial disability is different than it is for residual disability.
Residual Disability Benefits
Not all illnesses and disabilities are permanent. In some cases, claimants recover gradually over time.
- “Residual” definition of disability. In some policies – the claimant may not have to be totally disabled during the elimination period.
- In some circumstances, claimants may fall within the definition of both “total” and “residual” disability. When this happens, insurers are likely to claiming you qualify for residual benefits. It’s important that your lawyer defend your rights to a “totally disabled” benefit.
- Is limited from performing the material and substantial duties of his or her regular occupation
- As determined in the policy, has a qualified percentage of loss in monthly earnings due to the same sickness or injury
- If the claimant has more than the allotted non-disabled days set out in their policy – they may need to start a new elimination period.
- Benefit amounts are calculated according to a determined percentage.
- Generally, a total disability policy coupled with residual disability coverage provides the employee with the greatest income protection.
Do You Have Questions About Your Disability Coverage? Talk To A Personal Injury Lawyer As Soon As Possible.
Regardless of whether you have been denied disability income protection benefits under a group disability insurance policy or a private policy, an experienced personal injury lawyer is the wise choice when it comes to disability insurance claim disputes. Personal injury lawyers deal with insurance companies every single day. They fully understand the laws, strategies and tactics that insurers use to deny long term disability insurance claims. A qualified personal injury lawyer should:
- Help you interpret the details of your disability insurance policy
- Guide you through the process of filing a claim
- Help gather the necessary medical evidence to prove your disability as it pertains to your policy
- Advise you and insure that all actions take place within the required statutes of limitation.
- Litigate your disability insurance claim with aggressive and persistent legal advocacy
Remember, experienced legal advice can be the difference between a successful and unsuccessful claim.