The clauses that decide a disability claim take up a few paragraphs of a long contract, and this page quotes them as each insurer prints them. The contracts are Guardian's Provider Choice, Principal's Income Protector, MassMutual's Radius Choice, The Standard's Platinum Advantage, Ameritas's DInamic Cornerstone, and the Lloyd's certificate issued through Petersen International Underwriters. We checked every quote word for word against the PDF posted below in November 2026.
Seaworthy places coverage with the first five and uses Lloyd's for cases they will not write and as excess coverage above their limits, so Lloyd's appears as a sixth row wherever its certificate speaks to a provision. Each section pairs a table of clauses with a plain reading and a link to our longer guide, and the PDFs are listed for download near the end. Contract language varies by state and edition, and the issued policy governs.
How does each carrier define total disability?
Each carrier defines total disability as being unable, because of sickness or injury, to do the main duties of your own occupation, and the contracts split on a single condition, whether you can work in another occupation and still collect. Guardian, Principal, Ameritas, and Lloyd's print a definition without that bar. MassMutual and The Standard keep it in the base policy and lift it with an Own Occupation Rider.
| Carrier | Specimen clause (form, page) | What it means if you work elsewhere |
|---|---|---|
 | "You will be Totally Disabled even if You are Gainfully Employed in another occupation so long as, solely due to Injury or Sickness, You are not able to work in Your Occupation." (Provider Choice, ICC16 18ID, page 6) | Pays while you earn in another field, for the whole benefit period. The specimen also prints two-year versions, and this is the one Seaworthy places |
 | "You will be Totally Disabled even if You are Working in another occupation as long as You are unable to perform the Substantial and Material Duties of Your Own Occupation." (Income Protector, ICC22-800, page 6) | Pays while you earn in another field. Seaworthy always quotes this definition |
 | The base policy pays when "the Insured cannot perform the main duties of his/her Occupation and the Insured is not working at any occupation." The Own Occupation Rider pays an insured who "is working in another occupation" and cannot do the main duties of their own (Radius Choice, ICC15-XLIS-RC page 4, rider ICC20-OO-RC) | The base policy stops paying if you work elsewhere. The rider removes that condition, so confirm it is on the schedule |
 | The base policy requires that "you are not engaged in any other job or occupation for wage or profit" while disabled. The Own Occupation Rider rewrites the definition without that condition (Platinum Advantage, ICC17-B180 page 4, rider ICC17-PR206) | True own-occupation comes from the rider, which The Standard offers at classes 3A, 3P, 3D, and higher |
 | "Means that, solely due to your sickness or injury, you are not able to perform the material and substantial duties of your occupation, even if you are working in another occupation for wage or profit." (DInamic Cornerstone, ICC21 4601NC, schedule page 3A) | Pays while you earn in another field. Other schedules in the same specimen bar work in another occupation or limit own-occupation to 24 months |
 | "Total Disability means that solely due to an Accident or Sickness, You are not able to perform the substantial and material duties of Your Occupation, even if You are at work in another occupation." (Petersen certificate PDI111521, page 5) | Pays while you earn in another field |
The clause about other work decides what happens when you recover enough to teach, consult, or move into management. Under a definition that pays only while you are not working anywhere, the benefit stops when the new paycheck starts. A true own-occupation definition, one that keeps paying while you earn elsewhere, measures the claim against the work you did before you were disabled.
Guardian's specimen adds that Your Occupation "does not mean a specific job title, designation, industry, or job with a certain employer." That points the claim at your duties instead of your title. The Ameritas row quotes DInamic Cornerstone (form ICC21 4601NC), the product Seaworthy places outside California, and its California product, DInamic Foundation, is posted below as well. How each carrier delivers own-occupation, and where occupation class decides whether a rider is available, is set out in our own-occupation comparison by carrier.
What starts a partial (residual) claim, and how are prior earnings measured?
A partial claim starts when sickness or injury cuts your income by at least 15% under the Guardian, Principal, MassMutual, Ameritas, and Lloyd's riders, and by at least 20% under The Standard's. Residual disability is the benefit that pays a share of the monthly benefit in proportion to that loss while you keep working, and each contract measures the loss against its own definition of prior earnings.
| Carrier | Income loss that starts a claim (rider, page) | How prior earnings are measured |
|---|---|---|
| "Your Loss of Income is at least 15% of Your Prior Income" (Enhanced Partial Disability Benefit Rider, ICC20 EPID, page 1) | The greater of the last 24 calendar months or "the two calendar years with the highest earnings in the three calendar years just prior" to disability (ICC16 18ID, page 4) |
| A "Loss of Earnings greater than or equal to 15%" plus lost duties or full-time hours (Residual Disability and Recovery Benefit Rider, ICC22-800-RDRB, page 1) | "the two consecutive calendar years with the highest Earnings in the three calendar years prior to the claimed date of disability" |
| "a Loss of Income of at least 15% of Pre-Disability Income" with reduced capacity. Lost duties or time alone qualify in the first 6 months (Extended Partial Disability Benefits Rider, ICC15-EPS-RC, page 2) | The greatest of the last 12 months, the last 24, or the "highest consecutive 24 months during the 60 months prior to Disability" |
| "Your Loss Of Income must be at least 20% of your Indexed Predisability Earnings" (Enhanced Residual Disability Rider, ICC17-PR204, page 1) | The greater of "your highest average Earnings for any consecutive 12 months in the last 24 months" or two of the last three full tax years (ICC17-B180, page 22) |
| Requires that "your loss of monthly earnings is at least 15% of your prior monthly earnings" plus lost duties or time (Enhanced Plus Residual Disability Rider, ICC21 EPRES, page 1) | The greater of "any two of the past three full tax years" or "the 12 calendar months just prior to the onset date of disability" (ICC21 EPRES, page 2) |
| "a Loss of Earnings that is at least 15% of Your Prior Earnings" (optional Residual Disability Benefit Rider, EndResid060212, page 1) | "the highest twelve (12) consecutive months out of the last twenty four (24) calendar months" |
For anyone whose pay swings from year to year, such as a practice owner or an engineer paid partly in vesting equity, the look-back matters more than the threshold. Guardian, Principal, Ameritas, and The Standard each look back to two of the last three years, and MassMutual to the best 24 months of the last 60, so one weak year does not set a low baseline, while the Lloyd's rider starts from the best 12 of the last 24 months. Each rider in the table except the Lloyd's raises prior earnings for inflation once a claim passes its first year.
The monthly benefit math, from the early-claim minimum to the point where a large loss pays in full, is worked through in our residual disability benefits guide. Our software engineer page lines up those floors and full-benefit points for each of the five carriers.
How does the recovery benefit work in each contract?
A recovery benefit keeps paying a partial benefit after you return to full-time work while your income is still down from the same cause. The five major carriers write it into the residual riders quoted above, each with its own loss threshold and return-to-work test, and the Lloyd's forms on file print no recovery provision.
| Carrier | Specimen clause (form, page) | Loss that keeps it paying |
|---|---|---|
| "We will continue to consider You Partially Disabled, even if You have recovered from the Injury or Sickness that caused Partial Disability, so long as Your Loss of Income is still at least 15% of Your Prior Income" (ICC20 EPID, page 2) | 15%, from the same cause |
| Requires that "You return to Full Time Work immediately after a Continuous Disability" with "a Recovery Loss of Earnings equal to or greater than 20% of Your Recovery Prior Earnings" (ICC22-800-RDRB, page 3) | 20%. Ends after two months in a row without a loss above 20% |
| "The Recovery Benefit will be paid following the Insured's full recovery and return to his/her Occupation as it was being performed just prior to the start of Disability." (ICC15-EPS-RC, page 3) | 15%, with a demonstrated link to the earlier disability |
| Pays while you are "working at least as many hours as you worked prior to Disability" and "you continue to have a Loss Of Earnings of at least 20%" (ICC17-PR204, page 2) | 20%, from the same cause |
| Pays when you are "performing the material and substantial duties of your occupation, working at least as many hours as was usual for you prior to the start of your disability" (ICC21 EPRES, page 3) | 15%. Ends after two months in a row or three separate months below 15% |
| No recovery provision in the certificate or the residual rider on file (PDI111521, EndResid060212) | None printed |
The benefit covers the months after a claim when you are back at full hours and clients, patients, or billings have not caught up. Principal's rider asks for a 20% loss and a return to full-time work right after the disability, while Guardian's keeps treating you as partially disabled for as long as a 15% loss from the same cause continues. None of the five riders quoted here caps the recovery benefit at a fixed number of months, so each generally pays while the loss lasts, up to the end of the benefit period.
How does each contract limit mental and nervous claims?
Where a mental and nervous limitation applies, the five major carriers cap those claims at a set number of months, 24 in the MassMutual and Principal wording below, while the Lloyd's certificate on file excludes them outright. A mental and nervous limitation is a clause that ends benefits for a psychiatric or substance-related disability after that period, and each limitation clause quoted here keeps paying while you are confined as a hospital inpatient.
| Carrier | Specimen clause (form, page) | When it applies |
|---|---|---|
| "If the Policy includes a Mental and/or Substance-Related Disorders Benefit Limitation, it is shown in the Schedule Page." (ICC16 18ID, page 11) | Only when the schedule lists it, which Guardian requires for certain occupations and on California policies |
| "Monthly Benefits for Mental/Nervous/Substance Abuse Disability will not be paid for more than a total of 24 months" (limitation rider, ICC22-800-MNSA, page 2), counted over your lifetime or for each continuous disability depending on the version issued | Only with the rider, elected for a discount or required for certain occupations and states |
| "The Maximum Benefit Period is 24 months for each period of Disability caused, or contributed to, by a Mental Disorder." (ICC15-XLIS-RC, page 8) | Built into the base policy. An endorsement removes it outside California for eligible occupations |
| No limitation clause in the base form. The sample's premium summary lists a "Mental Disorder/Substance Abuse Limitation" among its discounts (ICC17-B180, page 3) | When elected for the discount or required by occupation class, and on every California policy |
| "we will not pay benefits for disabilities caused by or contributed to by mental/nervous disorders, alcoholism and/or drug abuse for more than the MNDA benefit period shown on the schedule" (ICC21 4601NC, page 8) | The schedule sets the period as a lifetime maximum in months |
| Lists "Mental and/or Nervous Disorders" among the causes for which "No benefits will be paid" (PDI111521, page 9) | Excluded outright on this certificate form |
On a capped policy, a disability from depression or anxiety that outlasts the cap stops paying at that point even if you still cannot work. Dementia caused by a stroke or by Alzheimer's disease is carved out of the mental disorder definitions in the Guardian, Principal, MassMutual, and Ameritas forms, so it is paid like any other sickness. In Texas, Principal's rider applies its 24 months to each continuous disability instead of to the life of the policy.
Who has to take the cap, and what full-benefit-period coverage cost in Seaworthy's 2026 quote study, is in our mental and nervous limitations guide.
When does each contract presume total disability?
Each contract, or at Principal its presumptive disability rider, presumes you totally disabled, even if you keep working, after a total loss of speech, of hearing in both ears, of sight in both eyes, or of the use of both hands, both feet, or one hand and one foot. Presumptive disability is the provision that pays the full benefit on that loss alone, and the contracts differ on whether the loss must be permanent.
| Carrier | Specimen clause (form, page) | Must the loss be permanent? |
|---|---|---|
| "We will consider You to be Totally Disabled even if You are Gainfully Employed if, while the Policy is in force, Injury or Sickness results in Your total and complete loss of" sight, hearing, speech, or the use of two limbs (ICC16 18ID, page 7) | No. Pays while the total disability continues, with the waiting period waived |
| Requires "total loss of use for any and every purpose or activity without any possibility of recovery of" speech, hearing, sight, or the use of two limbs (Presumptive Disability Benefit Rider, ICC22-800-PDB, page 1) | Yes, with the rider. Benefits start at the loss, without the waiting period |
| "The Insured is considered to have a Presumptive Total Disability even if he/she is able to work if certain conditions exist." (ICC15-XLIS-RC, page 3) | No permanence test for benefits. The waiting period is waived only if the loss is "complete and irrecoverable as of the onset of Disability" |
| Requires an Injury or Sickness that "results in your total and permanent loss of any of the following" (ICC17-B180, page 5) | Yes, with the waiting period waived |
| "benefits will begin to accrue from the date of the specific loss instead of after the elimination period" and "you may work at any occupation and still receive benefits" (ICC21 4601NC, page 6) | No |
| "The covered Benefit Amount will be paid as long as the loss exists, up to the Maximum Benefit Period." (PDI111521, page 7) | No, with the waiting period waived |
Permanence matters while recovery is still possible. A contract that requires a permanent loss presumes nothing until the loss is judged permanent, and the claim runs through the ordinary total disability test in the meantime. Guardian, Ameritas, and Lloyd's pay while the loss exists, MassMutual pays without a permanence test but waives the waiting period only for a loss that is complete and irrecoverable at onset, and The Standard counts sight as lost when it "measures at or below 20/200" in both eyes after correction. How a presumptive claim is documented and paid is covered in our presumptive disability guide.
Which contracts lock the premium, and which only guarantee renewal?
The Guardian, Principal, MassMutual, and Ameritas specimen forms are noncancelable, meaning neither the premium nor the terms can change before a stated age while you keep paying. The Standard's base form is guaranteed renewable, which fixes the terms but lets the premium change by risk class, and its Noncancelable Policy Rider converts it. The Lloyd's certificate runs for a set term.
| Carrier | Specimen clause (form, page) | Is the premium fixed? |
|---|---|---|
| "During that time, We cannot change the premium or cancel the Policy." (ICC16 18ID face page, noncancellable and guaranteed renewable to age 65 or 67) | Yes, to the expiration date at 65 or 67 |
| While the policy is in force, Principal cannot "Cancel it" or "Change the premium rate before the Policy Termination Date" (ICC22-800, page 1) | Yes, to the termination date, age 65 in the specimen |
| "This Policy is Non-Cancellable until the Policy Anniversary on or next following the Insured's 65th birthday." (ICC15-XLIS-RC face page) | Yes, to 65 |
| The base form says "we cannot change any part of the policy, except its premium, until the Termination Date." The Noncancelable Policy Rider changes it "from Guaranteed Renewable to Noncancelable and Guaranteed Renewable." (ICC17-B180 face page, rider ICC16-PR202) | Only with the rider. Otherwise the premium can change by risk class once the policy is three years old |
| "You have the right to continue this policy until age 65, or until the policy expiry date shown on the schedule, if later, by paying the premium as due." (ICC21 4601NC, page 10) | Yes. Ameritas may not raise the premium or add restrictions before 65 |
| "A new Term of Insurance may be offered at the Expiry Date of this Certificate, subject to underwriting." (PDI111521, page 14) | Fixed for the certificate term only |
Under The Standard's base form, a premium increase applies to a whole risk class once the policy is three years old, so the Noncancelable Policy Rider is worth confirming on any Standard quote. Each noncancelable form here becomes conditionally renewable after its stated age, at premiums that can change, and the Lloyd's certificate offers a new term at expiry only "subject to underwriting." The two guarantees are compared in full in our guaranteed renewable versus noncancelable guide.
How does each contract treat a pre-existing condition?
Each contract aims its pre-existing condition clause at conditions you did not disclose or misstated on the application, and the five major carriers' forms limit that defense to the first two years of coverage. A pre-existing condition, in these forms, is one you were treated for or had symptoms of during a set period before coverage began, from 365 days at The Standard to two years for treatment at the others.
| Carrier | Specimen clause (form, page) | How long it applies |
|---|---|---|
| "We will not cover any loss that begins in the first two years after the Effective Date from a Pre-existing Condition." The definition covers a condition "that was misrepresented or not disclosed in the application" (ICC16 18ID, pages 5 and 10) | First two years |
| No claim is paid for a disability that begins in the first two years and "Results from a pre-existing condition which was not disclosed or was misrepresented in this policy's application" (ICC22-800, page 8) | First two years |
| In the first 24 months, a pre-existing condition is covered when it "was fully and accurately described in the application for Coverage" (ICC15-XLIS-RC, page 8) | First 24 months |
| Benefits "will be payable only if the Pre-existing Condition is fully disclosed in the application and it is not specifically excluded from coverage by amendment or endorsement" (ICC17-B180, page 10) | Two years, after which the time-limit provision bars the defense except for fraud or a named exclusion (page 18) |
| "We will not pay benefits for any disability that starts within the first 24 months following the policy issue date and is caused by or contributed to by a pre-existing condition that was not fully disclosed on this policy's application." (ICC21 4601NC, page 9) | First 24 months |
| Excludes conditions "Not disclosed on the application" that were treated or caused symptoms in the 24 months before the certificate took effect (PDI111521, page 9) | No time limit printed |
For an applicant who answered every question fully, these clauses add little, because a disclosed condition is either covered or named in an exclusion rider attached at issue. The exclusion rider is the document to read, and our guide to exclusion riders and ratings covers how they are worded and when one can be reconsidered.
How should you read a specimen policy?
Read a specimen as a sample of the carrier's filed form, then check each clause again on the policy you are issued. Bracketed text and placeholder names mark the spots where an issued policy prints your own benefit, waiting period, and definition, and some specimens print alternatives side by side, as Guardian's and Ameritas's do for total disability.
Riders rewrite the base contract, which is how the MassMutual and Standard Own Occupation Riders replace their base definitions, so read the riders listed on the schedule page before the base policy. State forms differ too. The California and New York versions in the download table carry their own wording, and The Standard's interstate sample says "Not for use in CA, FL, MT, NY, ND, SD, WY" on its cover.
MassMutual's specimen notes that its provisions may have changed since it was created, and the Lloyd's certificate on file is the PDI111521 edition, so a policy issued today can differ from the sample in front of you. The issued policy governs.
Where can you download each carrier's specimen policy?
Most files below are the carrier's specimen or sample policy, posted as received. Principal's Income Protector file is the base policy, data page, and riders as filed with the Interstate Insurance Product Regulation Commission, combined into one PDF, and the Lloyd's residual rider is a separate file of blank rider pages.
| Carrier | Product | Form | States | Size | Download |
|---|---|---|---|---|---|
| Guardian | Provider Choice, issued by Berkshire Life Insurance Company of America | ICC16 18ID, with riders | Interstate compact form | 1.2 MB | Download PDF |
| Guardian | Provider Choice, issued by Berkshire Life Insurance Company of America | 18ID (01/2022) CA | California | 2.9 MB | Download PDF |
| MassMutual | Radius Choice, with its optional riders | ICC15-XLIS-RC | Interstate compact form, state variations apply | 1.6 MB | Download PDF |
| MassMutual | Radius Choice, with its optional riders | XLIS-RC-15(CA) | California | 3.2 MB | Download PDF |
| Principal | Disability income policy, California sample | HH 750 CA | California sample of the form Principal uses in California and New York | 315 KB | Download PDF |
| Principal | Income Protector, policy and riders as filed | ICC22-800-IDI, with riders | All states except California and New York | 3.0 MB | Download PDF |
| The Standard | Platinum Advantage annotated sample policy | ICC17-B180(07/17) | Not for use in CA, FL, MT, NY, ND, SD, WY | 714 KB | Download PDF |
| The Standard | Platinum Advantage annotated sample policy | B180(8/18)CA | California | 2.9 MB | Download PDF |
| The Standard | Platinum Advantage annotated sample policy, issued by The Standard Life Insurance Company of New York | B180AMR(9/16)NY | New York | 1.8 MB | Download PDF |
| Ameritas | DInamic Cornerstone noncancelable specimen | ICC21 4601NC, with riders | Approved states outside California, where it is the Ameritas product Seaworthy places | 633 KB | Download PDF |
| Ameritas | DInamic Foundation general specimen | 4501NC, with riders | Approved states. Ameritas sells Foundation in California | 1.4 MB | Download PDF |
| Ameritas | DInamic Foundation | 4501NC CA | California only | 727 KB | Download PDF |
| Lloyd's | Personal disability income certificate, executed by Petersen International Underwriters | PDI111521 | Current edition on file | 248 KB | Download PDF |
| Lloyd's | Residual Disability Benefit Rider and 65% earnings endorsement | EndResid060212 and EndROETTD24040112 | Edition on file | 22 KB | Download PDF |
Principal's Income Protector file is the policy, data page, and riders as filed with the Interstate Insurance Product Regulation Commission (approved February 2023).
How does Seaworthy use these clauses when comparing quotes?
When a quote comes back, the first clause we read is the total disability definition the carrier will issue, and where own-occupation comes from a rider, we confirm the rider is named on the schedule page before the client signs. Residual coverage is on more than 95% of the policies in Seaworthy's placed book (2026 audit), because most disabilities reduce income before they end work. So the next read is the residual rider's threshold and prior-earnings look-back, set against how the client is paid, and the five carriers' riders in the residual table above are the ones we quote.
Exclusion wording gets the closest read of all. Carriers attached an exclusion or rating to about 28% of the policies in Seaworthy's placed book (2026 audit), and mental and nervous conditions made up about 43% of those exclusions, so a mental health exclusion can shape a policy as much as the limitation clause quoted above. When an exclusion reaches further than the medical record supports, we ask the underwriter to narrow it or make it reconsiderable, and in our experience many come off about two years after issue once a clean interval has passed.
This page is educational, and nothing summarized here overrides the issued policy. To see how these clauses land on the policies you would be offered, start a quote comparison across the five carriers we place.