Generally, “Total Disability” in a long-term disability insurance policy means the inability to perform the material and substantial duties or important duties of your own occupation or of any occupation, depending on the definition in your policy. There is also an appropriate physician’s care requirement.
However, the definition of total disability varies from company to company and sometimes from policy to policy, depending on when the policy was issued. It is important to review your policy and understand the exact definition as it applies in your own long-term disability insurance policy. It is also extremely important to know and understand what is a material and substantial or essential or principal or important duty as it relates to the performance of your own occupation. We will assist you in having the most comprehensive understanding of how your disability insurance company will review your claim and how to best present your claim in the face of that analysis.
Residual disability, also known as partial disability, is when you are suffering from a disabling medical condition which is in some way negatively affecting your ability to work, but is not total disability. Generally, residual disability can be defined two different ways: it can be the ability to perform one or more, but not all, of the material and substantial, or important duties, of your own occupation, or the ability to perform all of the material and substantial, or important duties, of your own occupation, but for less time than before you became disabled. In addition, there is usually an income loss provision that must be satisfied as a result of your disabling medical condition.
However, it is important to review your policy and understand the exact definition as it applies in your own long-term disability insurance policy. It is important to understand the material and substantial duties of your own occupation and how they are impacted by your medical condition. It is imperative to understand the financial issues that must be satisfied and how the financial loss of earnings calculations under your policy provisions will be applied. It is very common for this definition to be combined with total disability in long-term disability policies. This in effect becomes a loss of earnings benefit. The application of this definition can be more complicated than if the definitions are separated out.
At Seltzer & Associates, we will assist you in understanding the definition of disability as it applies to your unique situation, including what your material and substantial duties are, how your disability insurance company will perform the financial analysis, and how it applies to your medical condition. We will help you understand how your disability insurance company will view your claim in light of your situation and how to best present the claim in the face of their analysis.