Total vs. Residual Benefits: What You Need to Know
If you become disabled for an extended period of time, disability insurance can provide financial protection. Disability policies pay benefits in the event you're unable to work at all ("total disability") or can work only some of the time ("residual" or "partial disability"). It's important to consider the different types of policies and their costs, so that you'll be able to select the coverage that's right for you.
Total disability occurs in the event you're unable to work at all, whether temporarily or for a long period of time. However, it's important to note that insurance policies can define "total disability" in different ways.
Presumptive Total Disability Coverage:
Most insurance companies presume certain conditions to be totally disabling. These conditions typically include:
- Loss of sight in both eyes
- Loss of hearing in both ears
- Loss of speech
- Loss of the use of both hands
- Loss of the use of both feet
- The use of only one hand and one foot
If you're affected by one of these conditions, you generally don't have to meet the usual requirements in order to be considered totally disabled. Additionally, you can receive the benefits immediately and continue to receive the benefits even if you're able to return to work.
Own Occupation Coverage:
An "own occupation" policy generally defines total disability as the inability of the policy holder to perform the substantial and material duties of his or her particular occupation. You need not be totally helpless and can even work in another occupation and receive disability benefits. Because the own occupation policy is broader in its coverage, it can be more expensive and may be unavailable for individuals working in riskier occupations or for those who have medical histories.
Any Occupation Coverage:
Other policies define "total disability" as the inability to perform the duties of any occupation. Such a definition is narrower than the definition found in an own occupation policy. Under this definition, you must be unable to work in any occupation, not just your own particular occupation. However, these policies typically define "disability" in terms of your ability to engage in any gainful occupation for which you are reasonably suited based on your education, work experience, and other factors.
It's important to note that many policies use both an "own occupation" definition of disability and an "any occupation" definition. You may purchase a policy that provides own occupation coverage for a limited period, such as two years. When this period ends you must meet the narrower "any occupation" definition of disability to continue receiving benefits. Long-term disability policies are often designed this way.
Residual and Partial Disability
"Residual disability" is generally defined as the inability to perform one or more duties of your occupation, or the inability to perform these duties as often as before, coupled with the loss of a significant percentage of your pre-disability income. While "partial disability" is similar to residual disability, the ways in which benefits are calculated for these two types of coverage differ.
Residual Disability Coverage:
Residual disability policies pay benefits according to the amount of income you have lost because of your disability. These policies pay benefits even if you can work part-time and are not totally disabled. The benefit is based on the percentage of income you earn working part-time in relation to what you used to earn when working full-time. Most companies require a loss of income of at least 20 percent compared to your pre-disability income in order to qualify for residual disability benefits.
However, depending on the policy, an individual receiving residual, rather than total, disability benefits may receive a reduced benefit or no benefit at all if her monthly income exceeds a certain percentage of pre-disability income. In some policies, in order to qualify for residual disability benefits you must first qualify for a period of total disability. You can purchase a stand-alone residual policy, known as an income replacement policy, or a total disability policy with residual coverage as a rider. The income replacement policy is generally less expensive than the total disability policy.
Partial Disability Coverage:
Partial disability coverage is similar to residual disability coverage. Both types of coverage pay benefits if you're able to perform some of the duties of your occupation. However, loss of income is not considered in partial disability. You're instead paid an amount equal to 50 percent (or sometimes less) of the benefit that you would earn if you were totally disabled. Importantly, the benefit period is much shorter, usually only 6 to 12 months.
Factors to Consider
Generally, the maximum amount of disability income that can be purchased is 70 percent of the policy holder's occupational earnings. In addition, the period of time between the commencement of the disability and the payment of monthly benefits, known as the "waiting period," generally runs from 30 days to one year. When deciding on a plan, there are a few basic considerations to take into account:
- Total disability policy with residual disability coverage provides the greatest level of protection but at a higher cost.
- Stand-alone residual disability coverage provides income protection at a lower cost.
- Partial disability coverage provides benefits for a short time and at the lowest cost.
- The cheaper the policy, the longer the waiting period is, generally.
Need Help with Your Disability Insurance? Call a Lawyer Today
Depending on your policy, you may fall within the definition of both "total" and "residual" disability. If so, be wary of your insurer claiming you are residually disabled when you may actually be totally disabled. Fortunately, in most states, ambiguous insurance contract language is read in favor of the insured. Confused? You're not alone. Have an experienced disability attorney help you decide which steps to take.