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 its own 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 which they engaged in before their disabilities—hence the term own occupation. Partially disabled people cannot perform all the important duties of their occupations—but could possibly 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 “own occupation” and depending on policy language also unable to do 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, with respect to 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 took place (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.
Denials of Disability Claims
Many people who receive denials of their SSD or individual or employee sponsored disability insurance claims assume they are out of options. However, many claims that begin with denials end up with approved 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 an SSD claim or a private, or employer sponsored 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 reviews to bolster your claim and refute the carriers 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 expert or financial expert.
An 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 court.
In either situation, denials can be disheartening, but there is the opportunity to fight for the monthly benefits that 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!
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 lets 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 (866) 270-3770 or contact us online for more information.