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Disability is not an “all or nothing” phenomenon. If you’ve been hurt in an accident or suffered a serious illness, you might recover some, but not all, of your former abilities. While you might not be confined to your bed all day, you might not be able to put in the long days that used to be a standard part of your practice. There’s a gray area of partial disability, and it is huge.

It hits professionals particularly hard, and among them, dentists are often affected the most because of the physical demands of the profession. A problem like chronic back pain or tremor in the hands might not be severe enough to end a career, but it can have a devastating effect on the profitability of a dental practice.

When a disability limits but does not fully prevent you from working, that is known as partial or residual disability. It affects a vast number of professionals, many of whom are unsure what to do about it. It’s hard to support a practice while working part-time. Yet bringing in other professionals to cover the gaps substantially reduces resources available for personal income.

Disability Insurance May Provide the Answer

What many dentists and other professionals fail to realize is that their long-term disability insurance policy may provide coverage for partial/residual disability situations. There is a way to continue practicing at a reduced capacity while maintaining an appropriate income. But it can be challenging to get insurance companies to approve claims for residual disabilities, so it is important to understand the potential difficulties and how to overcome them.

Although partial disability benefits can be a crucial piece of the financial security puzzle, securing that piece requires knowledge and persistence. When you’re recovering and rebuilding your life and professional practice, you may not have the bandwidth to learn the details of insurance law or the time to engage in depth with the insurance company. At Seltzer & Associates, our practice is entirely devoted to helping professionals receive full benefits from their insurance companies, so we know how encompassing the process can be. When you allow an experienced Pennsylvania disability insurance attorney to manage the claims process on your behalf, you can focus your energy on recovery and avoid mistakes that could result in delay or denial of benefits.

Residual Disability for Professionals

As noted above, residual disability is a gray area between total disability and functional ability. The full definition of residual disability will depend on the policy’s terms, but insurance companies may adopt an unreasonably strict definition of what it entails.

Contrasted with Total Disability

When an illness or injury prevents you from performing any of the material tasks that make up your profession, then you are considered to be suffering from a total disability. Policies will differ in the precise definition of total and partial disability, and even in the description of disability itself.

One key distinction is whether a policy is described as an “own occupation” or “any occupation” policy. An own occupation policy provides benefits if you are not able to perform the duties of the occupation you were engaged in at the time you became disabled. An any occupation policy will only provide benefits if you demonstrate that you’re unable to work at any occupation. 

Insurance companies often market policies in a way that makes them appear to provide own occupation coverage when the fine print says otherwise. One of the key tasks performed by a disability insurance lawyer is to dissect the language in the policy and other materials that form the basis of the contractual relationship, holding insurance companies accountable for the promises made to policyholders.

When a policyholder is able to work some but not to the full extent, then they are considered to suffer a residual disability. They are only partially able to work. Generally, the residual disability must reduce income by at least 20% to qualify for benefits, but this will depend on the policy’s specific provisions.

Three Ways a Professional May Qualify for Partial Disability Benefits

There are essentially three different sets of circumstances that can make a professional residually disabled.

• Inability to perform duties. A disability may prevent a professional from performing some of the profession’s substantial duties. Even though some abilities remain, the professional is not fully able to function. For instance, a dentist might be able to interpret X-rays and consult with patients, but not be able to lean over to perform lengthy tasks such as root canal procedures.
• Inability to work full hours. Physical or mental limitations may prevent a professional from working a full day or a full week as they once did. Being in the office for more than a few hours at a time can be overwhelming and may require more time than usual to rest and recuperate. Disabilities that result in chronic pain often allow a professional to work for short periods of time, but not all day.
• Loss of income. If the reason is a reduced workload, reduced hours, or the inability to perform work that is compensated at a higher rate, and a professional earns 20% less than before the onset of the disability, this can be a justification for receiving benefits for a residual disability.

Check the Fine Print in the Policy

Insurance companies do not always offer partial disability benefits as a standard feature in long-term disability insurance policies. It is frequently offered as a rider or optional feature. It is important to review a policy’s terms to determine whether residual disability is covered and what must be done to trigger that coverage. 

It is also important to understand how benefits are calculated. Frequently, payments are based on a percentage of the earnings after the disability compared with before the disability. But many factors can affect the amount, and the insurance company may argue that your ability to earn is greater than it actually is, or that your income prior to the onset of disability should be reduced for factors that may not be applicable.

Why Dentists Have Unique Vulnerability When it Comes to Disabilities

Disabling conditions often have a much greater impact on dental professionals than on those in other fields. What could be a minor injury for an accountant or attorney could make professional practice impossible for a dentist, oral surgeon, endodontist, orthodontist, or dental hygienist. That is because dental professionals rely on the fine motor skills they have honed through experience, coupled with physical and mental stamina, as they treat patients on a daily basis.

Some of the most common disabling conditions that impact dental professionals disproportionately include:

• Degenerative disc disease
• Other injuries or chronic pain in the neck or back
• Carpal tunnel syndrome
• Cardiovascular disease
• Vision problems
• Arthritis
• Mental health issues triggered by stress

Professionals in the field are often at risk, both financially and physically. The knowledge and expertise required to practice come at a high cost, with years and many thousands of dollars invested in education. A dental practice requires a substantial investment in equipment, overhead, and staff, and those expenses remain high even if the dentist practices only half as many hours or performs procedures that generate only small amounts of income.

Overcoming the Challenges with a Claim for Residual Disability

Dentists and other professionals who seek benefits for residual disabilities often have to fight an uphill battle against the insurance provider. To remain profitable, disability insurance providers are always working to limit payouts, and the easiest way to keep expenses down is to deny claims or limit benefits to low amounts. Sometimes they operate within the policy’s contractual constraints. Other times, they violate their obligations, hoping the policyholder will accept the outcome and give up.

Often, insurance companies will keep asking for more information and delaying benefits. Again, it seems they are engaged in a battle of wills to see whether they can get the claimant to drop the matter. An experienced disability insurance attorney will recognize when an insurer‘s bad-faith conduct is actionable and will know how to hold the insurer accountable.

When professionals file claims for partial disability benefits, insurance companies will often argue that the claimant is simply choosing to work less and that they haven’t proven they are unable to work more. It can be much more difficult to prove that a disabling condition truly limits the ability to work full hours. This is especially true in situations where a professional may have already reduced their hours or limited services before filing the claim for benefits. Disability insurance attorneys may call on experts who can explain how a particular disability limits the ability to perform particular job functions or reduces a professional’s stamina.

Reviewing a Policy

Professionals need to be aware of what coverage is provided under their disability insurance policy. Often, group policies offer limited coverage and may not cover partial disability claims, so it may be necessary to purchase an individual policy for full coverage.

For professionals to receive residual disability benefits, it is generally necessary to have a policy that provides own occupation coverage. Otherwise, the insurance company will probably find a way to argue that even with the limitations of the disability, the policyholder is able to perform some work well enough that they don’t qualify for benefits.

It is important to review the benefits for full and partial disability to ensure they provide adequate resources to cover the policyholder’s expenses. Professionals may want to consider purchasing business overhead expense insurance to cover the cost of running the practice if a disability reduces critical income.

Seltzer & Associates Understands How to Resolve Problems with All Aspects of Disability Insurance

We founded Seltzer & Associates decades ago because we saw that professionals were often having a much more difficult time than others recovering disability benefits. Insurance companies often challenge every aspect of a claim when a policyholder is a high-earning professional with extensive skills and complex job requirements. We know how to overcome their objections and meet their extensive requirements to recover the benefits that professionals deserve under their policies.

If you are just starting the claims process or have had your claim denied or delayed, we invite you to schedule a complimentary consultation to review options for recovering full benefits. If you have questions about the coverage in your policy, we’d be happy to perform a free policy review at any time. Just call us at 888-699-4222 or contact us online to get started.