CARD T239
Partial Disability
Disability involving reduced ability to perform occupational duties or work hours. Benefits depend on the policy’s definition.
How it works
Partial disability concerns a reduced ability to perform duties or work hours rather than complete inability under the policy standard. Some policies pay a stated fraction of the total benefit for a limited time; others use different formulas. A prior total-disability requirement may or may not apply. Partial and residual terms can overlap, so use the contract’s definitions. [19] [20]
An insured returns for half-days and performs only some duties. A partial benefit may apply if the stated conditions are met.
Reduced hours do not establish a universal payment percentage.
CARD T240
Residual Disability
A benefit approach addressing income loss while the insured can still work to some extent. Payment often reflects the qualifying reduction in earnings.
How it works
Residual disability benefits address qualifying earnings loss when an insured can work to some extent. A common proportional formula multiplies the full benefit by the percentage loss of income, subject to minimum loss thresholds, special initial benefits, and policy limits. It is not enough to have lower income for reasons unrelated to a covered disability. [19] [20]
Under a stated proportional formula, earnings fall from $5,000 to $3,000 due to covered disability: a 40% loss. A $2,500 full benefit yields $1,000 residual benefit before other adjustments.
Use income loss, not merely hours lost, when the specified formula is earnings-based.
CARD T241
Presumptive Disability
A severe loss specifically listed in a disability policy that is treated as qualifying disability without the ordinary occupational test. Permanent loss of sight in both eyes may be an example if the policy lists it.
How it works
Presumptive disability treats specified severe losses as qualifying under special policy terms, such as defined loss of sight, hearing, speech, or use of limbs. The precise losses and permanence requirements matter. Some policies waive an elimination period or pay despite continued employment; those features must not be assumed without wording. [19] [20]
A policy specifically lists permanent loss of sight in both eyes as presumptive disability. The claim is evaluated under that provision rather than assuming ordinary occupational tests are the only route.
A listed severe loss can trigger special treatment; not every injury is presumptive disability.
CARD T242
Recurrent Disability
A disability that returns after a period of recovery. Policy rules determine whether it continues the prior claim or starts a new one.
How it works
Recurrent disability returns after recovery. Policies commonly treat recurrence from the same or a related cause within a stated interval as continuation of the prior claim, which can avoid a new elimination period but use the remaining prior benefit period. A later recurrence or different cause may be a new claim. No single recurrence interval applies to all policies. [19] [20]
A policy treats the same cause recurring within six months as one claim. A recurrence after two months follows that continuation rule, assuming all conditions are met.
Continuation can avoid a new wait without granting a brand-new maximum benefit period.
APPLY THE TERMS
Practice questions
Select an answer, then check it to see why each option is right or wrong.
T239 · Partial Disability
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T240 · Residual Disability
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T241 · Presumptive Disability
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T242 · Recurrent Disability
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Sources & further reading
Original explanations and practice scenarios informed by the following regulatory, legal, and product resources. State examples are not presented as nationwide deadlines or requirements.