Partial Disability vs Total Disability: What’s The Difference?
Did you suffer a disability? Are you unable to work in any capacity, or can you work in some occupations—just not in the same profession as before the onset of your disability? For most insurance companies, whether you qualify as partially or totally disabled is determined by the specific language in the policy.
Your level of disability can determine the disability insurance benefits you receive.
How do you know if you’re partially disabled, totally disabled, or not disabled at all? In the latest video of our Disability FAQ series, we explain what each policy definition means and how each of them may relate to your occupation or training and potential disability benefits.
Each disability insurance company has different policies and specific policy language. Still, the basic ideas are universal. Despite the differences, disability insurance providers will describe a distinction between partial and total disabilities.
Put simply, partial disability means that, following a debilitating illness or injury—you are unable to perform some of the substantial and material duties of your occupation at the onset of disability.
Private insurance companies usually use language such as “own occupation” and “any occupation” to distinguish between requirements and benefits for total disabilities. They often offer a residual or part-time benefit if you can do some of the important duties but not all of them.
- “Own occupation” policies cover disabilities that prevent the insured from performing the important duties of their own occupation they engaged in onset of their disability—hence the term own occupation. Partially disabled people cannot perform all the important duties of their occupations—but could do some of their prior work or work part-time doing something for gain or profit.
- “Any occupation” policies provide benefits for people with disabilities that prevent them from performing the duties of any occupation by which they have been trained, educated, or suited, taking into consideration what they made in the 12 months or two years before they became disabled.
Common causes of partial disabilities may include:
- Heart attacks
- Neck and back problems
- Gastrointestinal problems
Total disabilities are, indeed, the more debilitating and often longer-lasting disabilities.
Total disabilities render the disabled person unable to work in their occupation, and depending on policy language may also be unable to fulfill the duties of any occupation, considering their training, education, experience, and their financial station in life.
SSDI only provides benefits for total disabilities but does have a trial nine-month return to work opportunity. To prove total disability for SSDI, claimants must show that:
- They can no longer work in their previous occupations
- They cannot adjust or learn to do any new professions
- Their disabilities will prevent them from returning to work for at least a year
There are different ways to demonstrate that you have a total disability that qualifies you for benefits:
You have a listed impairment – Both SSA and SSDI have categories of medical conditions set out that qualify as total disabilities. These often include neurological conditions, such as ALS, early-onset Alzheimer’s disease, or Parkinson’s disease, cystic fibrosis or other respiratory conditions, injuries such as severe traumatic brain injury, and several more.
If you can demonstrate that you have a listed impairment and the condition is at a certain advanced stage, you should qualify for total disability benefits under SSA or SSDI.
Your functional limitations prevent you from working—Even if your condition does not fall into a specific category listed in SSDI claims or by the SSA, you can still demonstrate that you cannot work due to your functional limitations. If your condition significantly limits your concentration or cognitive understanding, physical movement, or other abilities, you can provide evidence that your impairments prevent you from performing a job.
You may find it harder to qualify for benefits if your condition is not already recognized as disabling, but our attorneys regularly help disabled clients prove their inability to work so they can obtain the total disability benefits they need.
Significant Terms to Remember
Certain terms recur concerning disability insurance (whether SSDI, private, or employer-sponsored). Understand your disability policies so that you can appropriately document your disability claim. Ensure that your policies cover what you think they do, so that when and if you need to file a claim, your policy will provide timely benefits. Engaging one of the experienced lawyers at the top-rated disability insurance law firm of DarrasLaw at the outset can help, both with filing your disability claim and analyzing your policy.
Look in your disability insurance policy for the following important terms, see how they’re defined, and learn how your policy covers them:
- “True own” occupation: The most specific definition of disability, it generally covers a disability that leaves someone unable to perform the material and substantial duties of the occupation held at the time the sickness or injury claim was made (even if the claimant can be gainfully employed in another occupation).
- “Modified own” occupation: Covers a disability that leaves the insured unable to perform the material and substantial duties of their own occupation held at the time of the sickness or injury and the insured is not working at any occupation for gain or profit.
- “Any” occupation: You are unable to perform the material and substantial duties of any gainful employment for which you are qualified by training, experience, or education taking into consideration what you earned before your disability.
- Hybrid definitions: Some individual and long-term group disability policies will qualify a person as disabled based on “true own” or “modified own” occupation definitions of disability for a certain amount of time, generally 24 months or more. Then, to receive disability benefits past the initial “own occupation period,” the qualifying definition shifts from an “own occupation” definition to the “any occupation” definition.
What Evidence Do I Need to Prove My Partial or Total Disability?
No matter whether you are filing an individual disability claim or through an employer-sponsored group insurance policy, you should expect to have to present a significant amount of evidence to prove your disability claim. Each claim is different, and so will be the evidence you need to submit to support your claim.
For example, while the Employee Retirement Income Security Act of 1974 (ERISA) governs employer-sponsored disability benefits, each insurance company will still have different standards for qualifying for benefits and proving your disability under the policy terms. Knowing how to best prove your disability right from the start based on your policy can help you obtain benefits much sooner, and you can do this with the help of a respected disability insurance attorney.
What You Need to Prove
Insurance companies require you to prove certain aspects of your claim with supporting evidence, and some elements you will need to demonstrate include:
- Your disability onset date
- The last day you were able to work
- Your specific medical conditions that cause your disability
- Why you are unable to perform your occupational duties
- Who medically is certifying your inability to work
To make matters more complicated, you can expect the insurance company to challenge your claim at every turn, so you need strong medical, occupational and financial evidence to back up your disability. The insurer wants to show you can still engage in the functions of your occupation, so you must show otherwise. Below, we expound on what type of compelling evidence you need to prove each element of your claim.
Presenting Objective Evidence
You cannot simply submit a diagnosis and assume it is enough to prove all of the elements of your disability claim. Instead, you need to present objective and subjective medical evidence that relays facts and professional opinions about your condition and its disabling effects. Subjective evidence includes your own statements regarding fatigue, pain, or other challenges. Our disability attorneys can identify what evidence and testing you will need from licensed medical professionals to support your claim.
Proving Your Disability Onset Date
Proving this exact date is important for different reasons. First, if your insurer has a waiting period for benefits, you do not want them to use a later date, which will delay your monthly insurance benefit checks. If you are applying for Social Security disability benefits, your onset date helps determine the back benefits you might deserve. For these reasons, you want to prove the accurate date that your disability started.
Your medical records, chart notes, testing and treatment should indicate on which date you became unable to work (for total disability) or unable to perform some of your usual occupational duties (for partial disability). If there is no specific date in your medical records, you need to provide other records that show the severity of your disability at a certain time.
You might be able to speak with your doctors about your past diagnoses and records, so they can retroactively write up an objective opinion about when your disability started. We can advise you on the best way to present evidence of your disability onset date, as this is necessary for your claim.
Proving the Last Day You were Able to Work
Often, this date coincides with your disability onset date. However, some people might try to keep working even when they shouldn’t due to their condition and its effects. If you continued working, you need to give the insurance company an explanation why you tried or “just had to” keep working. You should also provide statements from your employer or other witnesses why you were unable to properly and satisfactorily perform the functions of your profession following the onset of your disability.
Proving Your Specific Medical Conditions that Cause Your Disability
You need to provide objective medical evidence if possible of the underlying cause of your disability, as well as its severity and concrete effects on your life.
This is true whether you have a physical or mental health condition, and you can provide test results, such as:
- CT scans, MRIs, X-rays, and other radiological imaging tests
- Bone marrow testing, blood work, and other lab tests
- Biopsies of tumors or tissue
- Psychological tests
In some cases, test results might eliminate the possibility of other conditions if yours is a diagnosis of exclusion.
Too often, claimants believe that simply handing over test results on their own will be enough, but this is not always true. If test results do not provide extensive or fully conclusive information about your disabling conditions, you can combine test results with objective medical opinions and notes to provide sufficient proof of your condition. Our award-winning disability attorneys can assist you in making sure that you provide all the proper medical information and testing and records needed to support the diagnosis of your underlying disabling medical condition.
Proving Why You Cannot Perform Your Occupational Duties
Simply having a medical diagnosis is far from enough to qualify for monthly disability insurance benefits, as you must also prove that your condition and its effects prevent you from performing either:
- Partial disability = Key functions of your occupation, limiting your ability to work full-time in your previous capacity and earning level
- Total disability = All of the duties of your occupation or any occupation (depending on your insurance policy terms), preventing you from gainful earnings
You can often begin with your medical provider’s assessment regarding your condition’s severity. For example, if your back injury is severe enough that you cannot lift anything or stand for prolonged periods, your doctor might indicate that you can only engage in sedentary work.
However, if your back injury prevents you from sitting for an hour or more, your doctor might opine that you cannot even perform sedentary work. You might present the results of a functional capacity test to prove your exact capabilities and limitations due to your disability.
In certain situations, you might need to seek an evaluation from an occupational expert, and our law firm can assist you, as we can direct you to a network of experts who are qualified to provide objective opinions in disability claims. You also might have to undergo an independent exam if the insurer requests one, and we can help you prepare for that “not so independent” evaluation.
Denials of Disability Insurance Claims
Many people who receive denials of their individual or employee-sponsored group disability insurance claims assume they are out of options. However, many claims that begin with denials end up with approved monthly insurance benefits. The process of appealing a denial is not a simple one, but a determined disability attorney can assist you. The appeal process will depend on whether you have a private, or employer-sponsored group disability insurance claim.
For SSD claims, the process can entail:
- Filing a request for reconsideration of your original claim
- Requesting a hearing before an administrative law judge (ALJ) within 60 days of having a reconsideration denied
- Request that the Appeals Council review your case, and the Council has the discretion to grant or deny this request unless there are specific factors present
- File a claim in federal court for the review of your denial, and the court might remand your case for reconsideration by the SSA
For individual and group disability insurance appeals, the process will depend on the reasons for the denial and other circumstances. Some appeals might involve:
- Identifying the reason or reasons for the denial
- Providing any incomplete or missing information or medical records
- Possible further medical testing and medical reviews to bolster your claim and refute the carrier’s medical reviews.
- Submitting written statements from physicians or even family, friends, or co-workers outlining your restrictions and limitations.
- Presenting the opinion of a vocational occupational or financial expert.
A seasoned disability attorney can help determine what types of information might help with your appeal. If the insurance company still upholds the denial, your lawyer could file a lawsuit against the insurance company in federal court.
In either situation, denials can leave you disheartened, but you can still fight for the monthly benefits you need for your partial or total disability. Appeals are challenging, so having the right legal assistance is always wise.
If You Have More Questions, or if Your Disability Claim Was Wrongfully Denied, Please Contact America’s Top-Rated Disability Insurance Law Firm, DarrasLaw, Today!
DarrasLaw offers free disability insurance claim consultations and free policy analysis. We will look over your policy with you and help you understand the limitations and exclusions it may contain.
If you filed a partial or total disability claim and received a denial of benefits, we can help determine whether your insurance company wrongfully delayed or denied your claim.
If your insurer has let you down, our nationwide disability insurance law firm and ERISA attorneys are here to assist and fight for the disability benefits you deserve. We evaluate disability cases throughout the United States.
The experienced, top-rated disability insurance lawyers and ERISA attorneys at DarrasLaw can help you understand and weigh your claim options. Call DarrasLaw today at (800) 458-4577 or contact us online for more information.