Pennsylvania disability income insurance practice questions
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Section 5.0 Disability Income and Related Insurance is 10% of the Pennsylvania Accident and Health exam (Series 16-02). [1] The outline lists how disability is defined (total, partial, residual, presumptive, recurrent), individual disability income policies and riders, the relation of earnings to insurance provision, Pennsylvania's minimum benefit standards, group short and long term disability, business disability coverage, and Social Security disability. [1] Several of these topics cite Pennsylvania regulations directly. This page explains them and gives 10 practice questions.
How Pennsylvania lets policies define disability
Total disability (31 Pa. Code 88.137). For the first 24 months after a loss begins, total disability is defined as being unable to perform all the substantial and material duties of the insured's regular occupation. After 24 months of continuous disability, the definition may change to being unable to perform the duties of any occupation for which the insured is reasonably suited by education, training or experience. A definition may not rest only on the ability to perform "any occupation whatsoever" or to take part in a training or rehabilitation program. The definition may require regular care by a physician who is not the insured or a member of the insured's immediate family. [2]
Partial disability (88.138). Partial disability may be defined as being unable to perform one or more, but not all, of the major, important or essential duties of the insured's work, or by a percentage of time worked, a number of hours, or compensation. If a policy pays both total and partial disability benefits, only one elimination period may be required. [3]
Residual disability (88.139). Residual disability is defined by the insured's reduction in earnings. [4]
Pennsylvania minimum standards (31 Pa. Code 88.167)
A disability income protection policy pays weekly or monthly benefits for a set period while disability from sickness or injury continues. It must: [5]
- keep payments made after age 62 that are reduced only because of age at no less than 50% of the amounts paid before 62;
- use an elimination period no longer than 90 days for a benefit period of 1 year or less, 180 days for more than 1 year up to 2 years, and 365 days in all other cases; and
- pay for at least 6 months of disability.
The policy may not require that an accidental injury disability begin within less than 30 days after the accident, may not require the insured to be confined to the home to receive benefits, and may not start the disability period on the date the insurer actually receives written notice. [5]
Relation of earnings to insurance (Insurance Company Law, section 618(B))
This optional provision lets the insurer reduce benefits proportionally if total loss of time benefits from all coverage exceed the insured's monthly earnings when disability began, or the average monthly earnings over the two years before, whichever is greater. It cannot cut total monthly benefits below $200 or the sum of the monthly benefits, whichever is less. It may be used only in a policy the insured can keep in force until at least age fifty, or for at least five years if issued after age forty-four. [6]
Social Security disability
The Social Security Administration says you qualify only if "You cannot do work you did previously or adjust to other work because of your medical condition," and the condition has lasted or is expected to last at least one year or to result in death. There is a five month waiting period. [7]
Practice questions
1. In the first 24 months of a claim, how may a Pennsylvania policy define total disability?
A. Unable to perform any occupation whatsoever
B. Unable to perform all the substantial and material duties of the insured's regular occupation
C. Confined to the home
D. Unable to take part in a rehabilitation program
Answer: B. (31 Pa. Code 88.137(a)) [2]
2. After 24 months of continuous disability, how may the definition change?
Answer: To inability to perform the duties of any occupation the insured is reasonably suited for by education, training or experience. (88.137(a)) [2]
3. A policy defines total disability only as being unable to do "any occupation whatsoever." Is that allowed?
Answer: No. Inability may not be based solely on that test. (88.137(b)(1)) [2]
4. A policy pays both total and partial disability. How many elimination periods may it require?
Answer: Only one. (31 Pa. Code 88.138) [3]
5. Residual disability is tied to what?
Answer: The insured's reduction in earnings. (31 Pa. Code 88.139) [4]
6. A disability income policy has a 2 year benefit period. What is the longest elimination period allowed?
Answer: 180 days. (31 Pa. Code 88.167(a)(2)(ii)) [5]
7. A policy cuts benefits at age 62 for age alone. What is the minimum it must keep paying?
Answer: At least 50% of the amount payable before 62. (88.167(a)(1)) [5]
8. Can a Pennsylvania disability policy require the insured to stay home to collect benefits?
Answer: No. No policy may require confinement to the residence as a condition of a disability income benefit. (88.167(d)) [5]
9. Under the relation of earnings provision, what is the lowest total monthly benefit it can reduce payments to?
Answer: $200 or the sum of the monthly benefits under all coverage, whichever is less. (Insurance Company Law, section 618(B)) [6]
10. How long is the waiting period for Social Security disability benefits?
Answer: Five months. [7]
Study tips for section 5.0
- Learn the 24 month switch from the insured's own occupation to any occupation the insured is reasonably suited for.
- For elimination periods, tie each number to the benefit period: 90, 180, 365.
- Relation of earnings compares benefits with current earnings or two year average earnings, whichever is greater.
- Group disability, business overhead, key employee and buy-sell coverage are also on the outline. [1]
Practice the whole A&H exam with our Pennsylvania accident and health practice test.
Prep Retention is independent and is not affiliated with PSI or the state.
Sources
Laws and exam documents quoted as of October 2026.
- PSI, Pennsylvania Accident and Health outline, Series 16-02 (effective 3/1/2026): https://proctor2.psionline.com/media/programs/PAINS/16-02xx.pdf
- 31 Pa. Code 88.137: https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/031/chapter88/s88.137.html&d=reduce
- 31 Pa. Code 88.138: https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/031/chapter88/s88.138.html&d=reduce
- 31 Pa. Code 88.139: https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/031/chapter88/s88.139.html&d=reduce
- 31 Pa. Code 88.167: https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/031/chapter88/s88.167.html&d=reduce
- Insurance Company Law of 1921 (Act of May 17, 1921, P.L. 682, No. 284), Section 618: https://www.palegis.us/statutes/unconsolidated/law-information/view-statute?iFrame=true&txtType=HTM&SessYr=1921&SessInd=0&ActNum=0284
- Social Security Administration, How You Qualify (disability): https://www.ssa.gov/benefits/disability/qualify.html