Residual disability benefits are common, in Florida and throughout the country — whether in the form of an insurance rider on a total coverage plan, or as a standalone income replacement policy — as a means with which to ensure that the claimant can secure at least some benefits after suffering a disabling event that is not necessarily catastrophic.
For example, if you are injured in a car accident, then you may suffer a disability in the form of back spasms, but this disability may not be “total” in the sense that you might be capable of performing your existing job. Residual benefits open up insurance coverage, to an extent, by allowing you to recover for disabilities that effect certain job duties, but that do not necessarily prevent you from working altogether.
Despite the fact that residual benefits are intended to fill the coverage gaps typical of total disability insurance policies, many insurers will challenge residual benefits claims and make it difficult for claimants to secure the benefits to which they’re entitled.
Qualifying for Benefits
Whether you actually qualify for residual benefits depends on the particularities of your insurance plan — there is no universal, consistent baseline for residual benefits, as plans can vary quite substantially. Residual benefits are a form of partial income replacement, and as such, many plans involve a showing of income loss of a sufficiently significant degree. For example, your plan may require that you demonstrate — post-disability — that your income has fallen at least 20 percent. Alternatively, your plan may also require that you prove that certain duties relating to your job (i.e., traveling and various physical duties required of a sales worker) are no longer possible, given your condition.
Residual Benefits vs. Partial Benefits
Residual disability benefits and partial disability benefits are similar (in that they allow the claimant to recover a reduced amount of disability benefits despite not qualifying as totally disabled), though there are a few notable differences, namely: a) how disability benefits are calculated, and b) the length of the payout.
Partial disability benefits are generally fixed at a certain percentage of the total disability benefits amount, and are therefore income-independent. If you qualify as “partially disabled” in accordance with the policy definitions, then you will be entitled to receive the partial disability benefit, regardless of whether your overall income has actually been affected.
By contrast, residual disability benefits are fundamentally dependent on income, and dynamically changes in accordance with income. Suppose that your total disability benefit would have been $3,000 per month. Due to your partial disability, however, your income drops 25 percent. You would therefore be entitled to 25 percent of the total disability benefit, or $750 per month.
Generally speaking, partial disability benefits coverage lasts for a short period of time, oftentimes just a single year. By contrast, residual benefits may payout for a lifetime, depending on the plan.
Contact Our Experienced Miami Disability Insurance Lawyers for Additional Guidance
Residual benefits are intended to fill gaps in insurance coverage that might otherwise give rise to no recovery in edge cases where you are not rendered totally disabled, but where your overall income and career have still been affected. Given the somewhat “fuzzy” nature of residual benefits coverage, they can quite easily lead to an aggressive dispute with an insurer that disagrees with your partial disability assessment. If you are involved in an insurance dispute relating to residual benefits coverage, then you’ll want to get in touch with a qualified attorney who understands how to successfully navigate the complications typical of such litigation.
Here at Ver Ploeg & Marino, P.A., our team of Miami disability insurance lawyers has over two decades of experience advocating on behalf of insurance claimants in a range of disputes, including those that involve residual benefits coverage issues. We believe that effective representation is that which focuses on the individual — as such, we work closely with clients throughout the litigation process and maintain open and transparent communication at every stage.
Call (305) 577-3996 to speak to one of our skilled Miami disability insurance lawyers.Share