Partial Vs. Total Disability Benefits in LTD Plans

When you’re dealing with a long-term disability (LTD) claim, understanding the difference between partial disability and total disability benefits can make a huge difference. These two categories affect how much you’re paid, how long you receive benefits, and even how your claim is evaluated by the insurance company.

This article breaks down what these two terms mean, how insurers decide which category you fall into, and what you can do if you think the insurer got it wrong.

Defining Partial Disability vs. Total Disability in Your Policy

The terms “partial disability” and “total disability” are fundamental in LTD policies, yet their definitions can vary between insurers. Typically, each is defined as:

• Total Disability: This means you’re completely unable to work. Depending on your policy, this might mean you can’t do your current job, or it might mean you can’t do any job at all. If you’re deemed to be totally disabled, you will typically qualify for the full benefit amount listed in your policy.
• Partial Disability: You can still work, but not like you used to. Given your injuries, you may only be able handle part-time hours or need a lower-stress job with reduced responsibilities. Partial disability benefits are meant to help make up for the drop in your income.

Understanding these definitions within your specific policy is crucial, as they determine your eligibility for different types of benefits. One of our Calgary personal injury lawyers can help you understand how you qualify, given the specifics of your case.

Medical Evidence Can Prove Your Impairment

No matter what kind of LTD claim you’re making, proving the extent of your disability requires comprehensive and detailed medical evidence. Insurance companies rely heavily on this documentation to assess your claim. Here’s what usually helps:

• Medical records: Reports from your doctors, specialists, and any hospital visits.
• Doctor’s notes: A written statement from your physician explaining what you can and can’t do.
• Diagnostic tests: Things like MRIs, CT scans, or X-rays that show the extent of your condition.
• Functional capacity evaluations (FCEs): Tests that measure your physical abilities, like how much you can lift, how long you can sit or stand, or how far you can walk.
• Expert Reports: your lawyer can hire independent experts to assess you and support your claim for your impairment. The expert will depend on your type of healt issue.

It’s not just about proving you have a medical condition—it’s about showing how that condition affects your ability to work, and medical evidence is a crucial part of demonstrating your ability, or lack thereof.

How Insurers Determine Payments

The amount you receive in LTD benefits depends on whether you’re classified as partially disabled or totally disabled. The following are standard distinction between benefits received for each category:

• Total disability benefits: If you’re considered totally disabled, most LTD policies pay around 60-70% of your pre-disability income. This is meant to help you cover your expenses given you can’t work at all.
• Partial disability benefits: Calculating partial disability benefits can be more complicated. If you’re working part-time or earning less than before, insurers usually cover a percentage of the income you’ve lost. So if you’re making 50% of your old salary, your LTD benefits could make up part of that gap.

Each insurance policy calculates these benefits differently, so it’s important to check the specifics of your plan and review them with a long-term disability lawyer.

How to Transition From Partial to Total Disability Benefits

Your injury or condition might initially qualify as only a partial disability but get worse over time. If that happens, you may need to transition to total disability benefits. If this transition is necessary, here are some of the things you will need to do:

• Keep your medical records up to date – Regular doctor visits, being thorough with your doctor, and submitting updated medical reports can help prove your condition is worsening.
• Let your insurance company know – Don’t wait until you’re completely unable to work. If you’re struggling more and more, notify your insurer early.
• Be prepared for re-evaluations – Your insurer will likely require new assessments to confirm you now qualify for total disability benefits.

Not all policies make this transition easy, so be sure to review the rules in your LTD plan with your lawyer.

Appealing Decisions

If you believe your insurer has misclassified your condition, resulting in denied or reduced benefits, you have the right to appeal.

Here’s what to do:

1. Have your lawyer review the denial letter carefully – The insurance company will explain why they made their decision. This helps your legal team figure out what evidence may be missing that could support your claim.
2. Gather more medical evidence – If your claim was denied due to a lack of proof, your lawyer may advise you to work with your doctor to provide stronger documentation.
3. File an appeal on time – Your LTD policy will have a deadline for appeals. Make sure you submit everything on time.

Our Calgary Long-Term Disability Lawyers Can Help

Knowing the difference between partial and total disability benefits can help you navigate your LTD claim with confidence. The key is understanding your policy, keeping thorough medical records, and being proactive if the insurer makes a mistake.

If you’re struggling with your LTD claim, contact our Calgary long-term disability lawyers today for a free consultation. You can call our toll-free, 24-hour line at 1-888-494-7191 to set up an appointment and we also welcome walk-ins at our downtown Calgary office.