Insurance Benefits: Partial vs. Total Disability

Depending on your insurance coverage, you may be eligible to submit an insurance claim for either total or partial disability.  Too often, however, insurers wrongfully deny, delay, or undervalue disabled policyholders’ claims so as to minimize their liabilities.  In the disability insurance context, for example, an insurer might define your disability as merely partial, when in fact the disability is totally debilitating with respect to your ability to work and earn a living.  If your insurer defines your disability as “partial” when the disability is actually “total,” you will lose out on substantial benefits that are necessary when your income-earning potential has been so thoroughly damaged.

Plans can vary quite a bit with regard to their provisions and definitions, so there are not necessarily one-size-fits-all truisms that apply to each and every disability insurance plan in Florida.  Generally speaking, however, there are certain ways in which insurers define total and partial disability that are worth keeping in mind as you begin the process of pursuing your rightful disability benefits.

Total Disability

Total disability can be defined differently between policies, but as a general rule, total disability tends to be linked to whether the policyholder can perform their material duties (with respect to their current occupation).  If the policyholder cannot perform the material duties of their occupation, then they may be entitled to receive total disability benefits.

Some disability insurance plans offer total disability benefits only if the policyholder can show that they have been rendered incapable of performing the material duties of any occupation — not just their current occupation.  For example, if you have suffered a serious back injury, you may not be capable of performing your material duties as a construction worker, but you may be capable of taking on a service-oriented job that does not involve physical labor.

Total disability can be particularly difficult to show in cases where your occupational duties are more flexible and less-defined.  By working with an attorney (and an industry expert), you may be able to identify material duties on which your claim can be based.  Of course, in some situations, the insurance plan will delineate specific conditions that are automatically counted as a “total disability,” such as blindness, deafness, and various other conditions.

Partial Disability

Partial disability is often purchased in addition to total disability coverage, for claimants who are concerned about injury scenarios where their income-earning potential is diminished but total disability coverage does not apply.

As with total disability, the definition of partial disability varies from plan-to-plan, but as a general rule, partial disability is linked to the policyholder having been rendered incapable of performing at least one material and major duty of their occupation, or having been rendered incapable of performing their duties for as much time as they were able to before the onset of their disability.  Further, partial disability may require that the policyholder demonstrate a loss of at least 20 to 30 percent of income (resulting from the disability).

For example, if you have sustained a neck injury that limits your ability to work at your desk for a lengthy period of time, your hours may be reduced at work, and you may therefore have a reduced income as a result.  Still, you would likely qualify for partial disability, and not total disability, as you can perform the necessary duties of your occupation.

Given the difficulty of securing disability benefits when your insurer is aggressively undervaluing, delaying, or denying your claims, it’s important that you work with a qualified Florida attorney who has a track record of successfully obtaining benefits for clients in a range of disability scenarios.

Ver Ploeg & Marino is a Florida insurance litigation firm that has represented clients in disability insurance disputes for more than two decades, from the wrongful denial or delay of benefits to bad faith insurance litigation against the insurer.  Our team of over twenty-five attorneys, spread between our Miami and Orlando offices, are committed to helping policyholders obtain their rightful disability benefits, and work closely with clients throughout the litigation process to ensure that our strategic objectives are aligned every step of the way.

Call (305) 577-3996 today to speak with one of our experienced Miami disability insurance lawyers.  During your initial consultation, we will assess your claims and help you develop a strategic road-map moving forward.

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