Disabled California workers need to make sure they aren’t misclassified

It can be an incredibly frightening experience for anyone to suffer a debilitating injury or illness. Not only must this person strive to get better – which can result in thousands of dollars in medical bills and rehab – but he or she may also be unable to work for months, or even years. Sadly, this one-two financial punch can quickly drain the bank accounts of even the most well-prepared Californians.

Thankfully, those workers lucky enough to have disability insurance may find themselves better prepared for these situations when disaster strikes. However, workers who file a disability insurance claim in California need to ensure that their insurance provider does not misclassify their disability as “residual” when it is actually “total.” After all, a misclassification such as this will result in the disabled worker receiving smaller disability benefit payments than he or she would otherwise be entitled to.

Differences between “total” and “residual” disability in California

Under California law, a “total” disability is one that renders the worker unable to perform the “substantial and material” duties needed in a particular job – a worker need not be in an absolute state of helplessness to qualify. Consequently, what is considered a “total” disability may change from job to job as different jobs have different duties.

Interestingly, even though the California Insurance Code expressly states that insurance policies have the power to set forth the meaning of what is considered “totally” disabled, case law has indicated that this power is not absolute. For instance, a policy cannot use a definition of “total disability” that is more limiting than the “substantial and material” standard set forth above. As a result, California courts are permitted to deviate from clear policy definitions of “total disability” in order to protect disabled California workers who can longer perform the substantial and material duties of their jobs.

Conversely, a “residual” disability – also commonly referred to as a “partial” disability – generally describes a disability in which a worker can still perform one or more of his or her substantial work duties and is not totally disabled. Often, insurance policies will define “residual” disabilities as a percentage of work functions a worker is now able to perform or a percentage of income lost due to the disability.

In addition, benefits payments for partial disabilities are commonly computed as a percentage of benefits for total disabilities, and in proportion to the level of the partial disability. For instance, if a worker is unable to perform 80 percent of his or her job duties, then the worker would be entitled to only 80 percent of what he or she would have received if the disability had been classified as total disability – meaning a misclassification can cost the disabled worker substantial benefits.

Unfortunately, insurance companies may attempt to classify a disabled worker as partially disabled in an effort to avoid paying full disability benefits – even though under California law the worker may be considered totally disabled. Accordingly, if you or a loved one is currently facing this type of situation with your insurance provider, it is often best to contact a knowledgeable disability insurance claim attorney. An experienced attorney can help ensure you are classified correctly and that you get the full benefit payments you may be entitled to under the law.