A litigator recovering from a health event returns to work. She’s still recovering, and can only handle half her usual caseload. Her firm’s group disability plan already agreed months ago that she qualifies for disability benefits.

What it never had to settle is how much she gets paid for working at reduced capacity. Some plans answer that with a clear formula. Others leave it to a provision nobody reads until the day it matters, and some leave it unanswered entirely.

Attorney disability insurance is usually framed around the moment coverage starts paying. The truth is that language says far less about what happens once someone is working again, at reduced capacity, on the same plan.

Michelle L. Roberts has spent more than 21 years reading disability insurance plan documents that settle exactly this question. She is the principal of Roberts Disability Law, P.C. in the San Francisco Bay Area, a Berkeley-trained lawyer who has represented disability claimants, and only claimants, since 2005, first in plaintiff-side litigation and later as a partner at Kantor & Kantor.

This article is about why a group plan can leave that number undefined, and what an individual policy’s own rider has to spell out instead.

Whether a Plan Pays Anything for Partial Work Depends on How It’s Funded

Roberts starts from the general rule before she gets to the exception. In her experience, most group plans include some kind of partial disability benefit. A litigator working half her usual caseload should expect the plan to pay something proportional to what she lost, not nothing simply because she can still bill some hours.

The exception is where a plan’s own structure gets in the way.

“Particularly self-funded plans, like these big companies, a lot of times pharmaceutical companies, they self-fund, they don’t have that. They might have some real rehabilitative employment provision that says, okay, we’ll let you work part time, but it’s got to be something we approve. But there’s no partial disability.”

Michelle L. Roberts, a benefits attorney who has reviewed employer disability plan language for two decades

A large firm that self-insures its own benefits is not automatically writing the same partial-disability language a carrier’s standard contract includes. What often replaces it is a discretionary provision that lets the employer approve reduced-hours work case by case, with no guaranteed proportional payment attached. Reading the actual plan document, not the benefits summary handed out at onboarding, is the only way to know which version a firm offers, and requesting it is a right guaranteed under the Employee Retirement Income Security Act, not a favor the employer can decline.

An Individual Rider Has to State Its Formula. A Group Plan Rarely Does.

“If you don’t believe in partial disability, if you don’t believe that somebody can only work 60% and not 100%, why do you have a partial disability policy? Just make it a total disability. Make it all or nothing.”

Michelle L. Roberts, past president of the Federal Bar Association’s Northern California chapter and principal of Roberts Disability Law, P.C.

A plan that offers a partial benefit at all is conceding, by design, that someone can work at reduced capacity and still be owed money for the difference. A group plan rarely follows that logic through to a stated number. Even a plan with a real partial-disability provision usually leaves the calculation to a sentence or two, with no fixed formula attached, which is also why a reviewer tends to apply more scrutiny the closer someone’s hours climb back toward full time. There is nothing precise to point to, so a carrier’s reviewer decides case by case.

A policy an attorney buys herself removes that ambiguity, because the formula is the product being sold. On an individual policy, this feature is usually called a residual or enhanced residual disability rider, and it works on a defined threshold rather than a reviewer’s judgment call.

Guardian’s individual contract does exactly that. Its Enhanced Partial Disability Benefit Rider (Guardian’s specimen policy) pays the full loss of income for the first 12 months of a partial claim, with a floor of 50 percent of the monthly benefit and a cap at the full monthly benefit. After that, the payment follows a stated formula: the percentage of income actually lost, multiplied by the monthly benefit, with any loss above 75 percent of prior income treated as a full loss. Nothing in that formula waits on an employer’s approval or a reviewer’s judgment call. It is written down before the claim ever happens.

That is the real difference between the two. A group plan’s partial benefit, where one exists, depends on a provision an attorney may never see spelled out in full. An individual rider’s partial benefit depends on a formula she could have read years before she needed it, and carriers structure that formula differently enough to be worth comparing before she buys.

The full conversation is on the Income Protection Journal Podcast episode covering pre-existing condition exclusions in group LTD coverage, including how two carriers covering one professional can reach opposite conclusions on the identical disability, the exact wage floor an any-occupation definition has to include before a lower-paying job stops counting against a benefit, and a third provision buried in the same plans that has nothing to do with the disability check at all. The disability determination is the part everyone worries about in advance. Whether a partial benefit pays what she expects is the part almost nobody reads until they are already living inside the answer, unless the formula was written down from the start.