Applying for Short Term Disability Benefits

applying-benefitsApplying for short term disability benefits means different things to different people, in different circumstances. The term “applying” can have two meanings.

For some people it means “what application form must I complete to purchase a policy?” For others it means, “how do if file a short term disability claim”.

Both questions are addressed in detail below.

  • Policy application forms
    • Applying while pregnant
  • Filing your claims form
    • Maternity leave
  • Qualifying conditions and requirements

Short Term Disability Application Forms

Short term disability application forms need to be completed in order to purchase a policy. This is the first and most important step to take for people wanting supplemental short term disability coverage. People covered by state mandated programs are automatically enrolled, and do not need to take positive action. Employees with employer paid group plans also are automatically enrolled, and do not need to complete a policy application.

The need to complete a policy application often creates confusion. There is little consistency around who is automatically enrolled, and who needs to complete a policy application. Only five states have mandated programs, but they are the larger states. People in other states often mistakenly assume they are automatically covered. They are not.

Applying While Pregnant

Applying for short term disability while pregnant is a frequent question that results from this confusion. Women who are already expecting can purchase a policy, but her existing pregnancy will not be covered. Preexisting conditions are not covered until 12 months after the policy effective date.

Many women search online frantically looking to purchase a policy while pregnant. Purchasing a policy is very different from filing a claim for payments. Coverage must begin prior to conception, or your claim will be denied. If you work in one of the five states with mandated coverage, or your employer provides a group plan, then your coverage probably began in time to cover you while pregnant.

Filing a Short Term Disability Claim

Filing a short term disability claim requires that you first identify the issuing company. Download an online claims form, and follow the instructions carefully. If you work in a state with mandated coverage, visit the state’s department of labor and download an online claims form.

Filing for Maternity Leave

How do you file for short term disability for maternity leave? Filing a claim for maternity leave benefits after a normal delivery is simple. After delivering your child, complete a specialized maternity leave claim form. Since the benefit period is fixed, six weeks for vaginal delivery and eight weeks for c-section delivery, your benefit can be paid upfront in a single lump sum. Your doctor will need to sign the claim form indicating only the type of delivery. There is no need to explain why you can’t work. The reason is understood.

Most disability companies will want you to file your claim only after you are unable to work. If you and baby are perfectly healthy, filing a claim for benefits while pregnant will likely result in a denial of your claim. For normal pregnancy, it is best to wait until after giving birth to file your claim.

Filing for Pregnancy Bed Rest

It is quite common for women to start maternity leave prior to giving birth. After all, who wants to work right up until the day of delivery? Doing so puts your health and the viability of your infant at risk. Most disability plans will not cover any pregnancy leave that occurs prior to delivery unless there is a medically certified reason why you can no longer work. A simple need or desire for bed rest is not adequate.

Your doctor will need to certify that your pregnancy is experiencing some type of abnormality, or that your pregnancy prevents you from performing the regular duties of your full-time occupation. If your employer is unwilling or unable to accommodate your condition, it is possible that the insurance company will pay your claim.

Qualifying Condition and Requirements

When applying for short term disability benefits you should understand the qualifying medical conditions, and other requirements. The most commonly asked about qualifying conditions and requirements are listed here. Consult your policy for greater details.

Depression and Stress Leave

Most private and state mandated short term disability programs are designed to cover biologically based medical conditions. Mental health issues are rarely covered except for Alzheimer’s disease – which often has an organic origin. This question arises frequently with women after childbirth. Postpartum depression is a common mental health issue, and often interferes with work.

Check your policy language carefully if you need to apply for short term disability benefits for: anxiety, depression, and postpartum depression, stress leave, etc.

Unemployment

If you become disabled while unemployed the claims application requirements change. You can feel confident applying for benefits while unemployed if you are confined to home, under the regular care of a doctor, and unable to perform two or more activities of daily living.

Unemployment compensation may be available to support income during a period of disability in six states. Federal laws were passed in 2009 which expand eligibility to include “compelling family reasons”. Each state applies these rules differently. Six include an employee’s own disability as a qualifying requirement.

Filing Appeal Letters

If your claim is denied you may need to file a short term disability claims appeal letter. Many claims are denied because of insufficient documentation, or the claims instructions were not followed properly. Carefully review your denial letter to understand the reasons for why the claim was turned down.

An attorney can help file the appeal letter, but make sure that your documentation is correct before hiring an attorney. Attorneys don’t work for free. Compare their charges with the expected benefit amount you are seeking to recover. In many cases the total claims amounts for short term disability are too small to warrant legal expenses.