While many are familiar with the concept of total disability, there’s another facet of disability insurance that often remains less understood but equally essential: residual disability benefits. These benefits are sometimes called partial disability benefits. These benefits come into play if you experience a partial disability, allowing you to receive compensation for the income loss resulting from your reduced ability to work.
In this article, we’ll explore the key aspects of residual disability benefits, including how they work, benefit calculations, what to consider when filing a claim, and how a long term disability attorney at The Maddox Firm can help.
What are residual or partial disability benefits?
Residual disability benefits are designed to provide financial support if you are partially disabled and can still work to some extent but are facing a reduction in your income due to your disability. These benefits are often provided as a residual or partial disability benefit rider, an optional add-on feature that can be attached to a short or long term disability insurance policy. This rider enhances the coverage provided by the base disability insurance policy.
To qualify for residual disability benefits, you must typically experience a loss of income compared to your pre-disability earnings due to a medical condition. The exact criteria for income loss can vary depending on the terms of your insurance policy. Like other disability insurance benefits, there may be an elimination period after the onset of your disability before you become eligible for residual disability benefits. During this waiting period, you may need to rely on other sources of income or savings.
The availability and terms of residual disability benefits can vary widely. It’s always recommended you consult with an experienced long term disability attorney who can carefully review your disability insurance policies to help you understand the coverage provided.
What is the difference between a total disability and a residual disability?
Total disability and partial or residual disability are two distinct concepts in the context of disability insurance, and they refer to different levels of disability and eligibility for benefits.
Total disability refers to a situation in which you are completely unable to perform the essential duties of your occupation due to an injury or illness (either in your own occupation or any occupation, depending on your policy terms). On the other hand, residual disability applies when you are not completely disabled but experience a partial disability that impacts your ability to work and earn income. With residual disability, you can still perform some of your occupational duties but at a reduced capacity due to injury or illness.
For example, let’s say you are an accountant who spends extensive time working at a computer desk. You suffer a cervical injury that limits your ability to sit for extended periods. You may need to cut back your schedule from five days a week to two days due to your spinal pain. Residual disability benefits would cover your lost income due to your reduced capacity.
Both total and residual disability benefits require you to provide your insurance company with proof of your disability, typically through medical documentation and other information that demonstrates how your condition impacts your work performance. The evidence required for total disability may focus on the complete inability to work, whereas for residual disability, it may emphasize your reduction in income and capacity to perform occupational duties. We’ll explore what documentation you can use to prove residual disability further below.
How much do partial or residual disability benefits pay?
Residual disability benefits pay a portion of your lost income when you experience a partial disability that results in a reduction in your earning capacity. The specific amount that residual disability benefits pay can vary based on the terms and conditions outlined in your disability insurance policy.
Here’s a general overview of how residual disability benefits are typically calculated:
Percentage of Income Loss: Residual disability benefits are often calculated as a percentage of the income loss you suffered due to your partial disability. The percentage is specified in your insurance policy and can vary from one policy to another.
Pre-Disability Earnings: To determine your income loss, your insurance company will usually compare your current earnings during the period of residual disability to your pre-disability earnings. This definition may or may not include bonuses, commissions, or other incentive pay.
Minimum Loss Requirement: Some policies may have a minimum loss requirement, meaning that you must experience a certain level of income loss before partial disability benefits are payable.
Coordination with Other Income: Your policy may also specify how residual disability benefits interact with other sources of income, such as earnings from part-time work or other disability benefits.
Recurrent Provisions: Some policies have recurrent provisions that allow for additional benefits if you experience recurrent episodes of residual disability within a certain timeframe.
If you are considering filing for partial or residual disability, you should carefully review your specific disability insurance policy to understand how residual disability benefits are calculated and the conditions under which they will be paid. Consulting with a disability insurance attorney can help clarify the details of your policy and how residual disability benefits are determined in your particular case.
How long can I receive residual disability benefits?
Residual disability benefits are typically subject to several factors that determine their duration:
Policy Terms: The maximum duration of partial or residual disability benefits is usually specified in your policy. This can vary from one policy to another but is often defined as a specific number of months or years (e.g., 12 months, 24 months, or until Social Security retirement age).
Recovery: Partial or residual disability benefits may cease if you recover to the point where your income returns to pre-disability levels or if you are no longer considered partially disabled according to your policy’s criteria.
Recurrent Disability: Some policies include provisions that allow for the continuation of residual disability benefits if you experience recurrent episodes of partial disability within a specified timeframe.
Keep in mind that the terms for residual disability benefits can differ from one insurance policy to another. If you have questions about the duration or any other aspects of your policy, it’s advisable to consult with an long term disability attorney who can provide guidance and help you interpret the details of your policy.
How do I prove residual disability to my insurance company?
Proving residual disability to your insurance company typically involves providing documentation and evidence to demonstrate that you meet your policy’s criteria for partial disability and income loss.
Here are some types of documentation you can submit to support your residual disability claim:
Medical Records: These are crucial to establish the existence and severity of your partial disability. Include reports from your treating physicians, specialists, and any relevant medical tests or imaging.
Diagnosis and Treatment Plans: Documentation that outlines your diagnosis, prognosis, and recommended treatment plans can help demonstrate the medical basis for your claim.
Functional Capacity Evaluation (“FCE”): An FCE is a comprehensive assessment conducted by a healthcare provider to evaluate your physical capabilities, which can be useful in demonstrating the extent of your disability and how it impacts your ability to perform work-related tasks.
Medication and Prescription Records: Provide records of prescribed medications, their dosages, and any side effects can show the medical necessity of your treatment.
Opinion Letters from Healthcare Providers: Letters from your treating physicians or specialists explaining the nature of your disability and its impact on your ability to work can be compelling evidence.
Work History and Job Descriptions: Documentation of your work history, job descriptions, and any physical or mental requirements of your occupation can help establish the link between your disability and your inability to perform your job.
Income Records: Financial records, such as tax returns, pay stubs, and financial statements, are essential to demonstrate the reduction in your income due to your partial disability.
Employer Statements: Statements from your employer confirming your job status, the impact of your disability on your work, and any accommodations or modifications made to your job duties can be beneficial.
Witness Statements: Statements from colleagues, supervisors, or family members who can attest to the impact of your disability on your ability to work and perform daily activities can be valuable.
Proving residual disability benefits to your insurance company can present unique challenges because these benefits often require a detailed assessment of your partial disability and income loss. Unlike total disability, where the inability to work may be clear-cut, proving partial disability can be more complex. You must demonstrate that you are still partially capable of working but that your ability to earn income has been significantly reduced due to your condition.
Determining the extent of your income loss accurately can be challenging. Your insurer may scrutinize your financial records and require documentation showing your pre-disability earnings and post-disability income. If you have other sources of income or disability coverage, such as workers’ compensation or Social Security Disability Insurance (“SSDI”), coordinating these benefits with your residual disability claim can be complex.
To navigate these challenges effectively, it’s crucial to thoroughly understand your disability insurance policy, maintain detailed records, and provide your insurance company with the necessary financial, medical, and vocational documentation demonstrating your residual disability. Seeking professional assistance from an attorney can help you overcome difficulties in the claims process or if your claim is denied.
How can The Maddox Firm help me prove residual disability?
The Maddox Firm has helped hundreds of clients receive disability benefits, including residual disability. We understand how to prove to your insurance company that you have suffered significant income loss due to your condition.
Here are some of the ways The Maddox Firm can help you file for residual disability:
We examine your partial/residual disability provision or rider: Our experienced team can thoroughly examine your disability insurance policy to understand its terms, conditions, and definitions related to residual disability. This allows us to determine whether you meet the criteria for these benefits and what will be necessary for your insurance company to approve you for residual disability.
We prepare your partial/residual disability claim: The Maddox Firm will help you prepare and organize your residual disability claim. This includes gathering the necessary documentation, such as medical records, financial records, and other evidence, to support your claim.
We help you calculate your disability benefits: Determining residual disability benefits involves calculating your pre-disability income with your post-disability income. Your insurance company may dispute the amount of benefits you are entitled to. The Maddox Firm will review your financial documentation and statements to calculate your benefit amount and provide our analysis to your insurance company to ensure they don’t undercut what you are owed.
We help you complete your claim forms: Your insurance company will require claimant forms to be submitted when filing your claim. The Maddox Firm can help you complete the claim forms accurately and ensure that all required information is included while meeting your insurance company’s deadlines.
We obtain, review, and submit your medical evidence: The Maddox Firm works with your healthcare providers to obtain and compile the necessary medical evidence to substantiate your claim. This includes medical records, treatment plans, and expert opinions. Your insurance company will likely require your providers to complete questionnaires. The Maddox Firm ensures that your doctor completes the form accurately and supplements the form with an expert opinion letter further detailing your condition and symptoms.
We can file an appeal or help you sue your insurance company: If your claim is denied, The Maddox Firm can guide you through the administrative appeals process. We will help you prepare a strong appeal, gather additional evidence, and present your case effectively to your insurance company. In cases where disputes cannot be resolved through an appeal, we can represent you in court and file a lawsuit against your insurance company on your behalf.
When dealing with a complex residual disability insurance claim, The Maddox Firm can provide guidance to help you understand your eligibility for benefits and how best to protect your interests. Our knowledgeable team will look over your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your partial/residual disability claim.
Contact us to help you file your claim, appeal, or litigation the right way.