Short term disability qualifying conditions are too numerous to list, but categories of excluded medical events can help narrow down eligibility to file a claim. Many medical events qualify to receive benefits, and some do not.
Common policy exclusions are briefer and finite. The exclusions can help define the boundaries of which conditions and events are eligible, and those that are not. If your medical condition is not excluded, there is a good chance that you may meet the qualifications.
- Accidental injuries
- On and off the job
- Eligible illnesses
- Preexisting conditions
There is one universal short term disability qualification that applies to both accidents and illnesses. The medical condition must prevent you from performing the primary duties of your full time occupation. Dig into the details about the qualifications specific to accidents and illnesses.
Accidental Injury Qualifications
When people think about becoming disabled they often first think about accidental injuries, even though seventy-five percent of eligible short term disability conditions are illness related. Apparently we are more comfortable envisioning ourselves getting hurt than getting sick.
An accidental injury may be a qualifying medical event for short term disability if it occurs after the policy effective date, and occurs while the policy is in force, and is not specifically excluded in the policy.
Individual short term disability policies are an ideal fit for people concerned about losing income from a future accident. So what types of injuries may be excluded?
There are a number of injuries that may be excluded as a qualifying medical condition by your policy. Each policy is different, so read the exclusion language carefully. Below is a sample list of possible injury exclusions a policy might contain.
- Piloting or as a passenger in a private aircraft without a published schedule.
- While committing a felony.
- While working at an illegal job
- Riding or driving in a motor vehicle race or stunt show
- Practicing for or playing in any professional sport
- Trying to commit suicide or any intentional injury
- Being exposed to an act of war
- Serving in the armed forces
On the job injuries are most frequently a qualification for workers compensation. Most injuries that occur while working are not eligible under short term disability. Some policies do contain a rider option to cover on the job accidents at a reduced benefit. Again, it is important to read what your policy states about on the job accidents.
Short Term Disability Qualifying Illnesses
A short term disability qualifying illness can be defined as a sickness, infection, or disease or other abnormal medical condition which is diagnosed after the policy effective date, causes a loss of income while the policy is in force, and is not specifically excluded by the policy.
That sentence covers a lot of ground, and warrants breaking down it more digestible pieces. The biggest issue we see by far relates to when the illness is diagnosed. Most of the inquiries we get come from people seeking to purchase a policy after the diagnosis, when the primary qualification is the opposite.
Preexisting conditions are the most frequent reason behind why policy applications get declined, and claims for benefits are denied. Many people mistakenly assume that they are covered by a state mandated program, when only five states have such a regulation.
A preexisting condition can be defined as having an illness or medical condition for which you received medical advice, treatment, or took prescription medications twelve months prior to the policy effective date. Any disabling event that occurs during the first twelve months of the policy effective date that results from a preexisting condition may not be eligible.
Pregnancy and Childbirth
Pregnancy and childbirth are the most common short term disability qualifications, but also the most frequent source of denials. Far too many women end up taking unpaid time away from work simply because they are unaware of the rules, or their employer does not offer them a voluntary option.
There are three main key considerations relating to eligibility:
- Coverage must begin prior to conception
- Normal childbirth must occur nine months after the policy effective date
- Policies covering normal childbirth are not sold directly to individuals
More women would qualify for paid maternity leave if they knew to purchase a policy prior to conception, and their employer offered a voluntary option. Increase the eligibility of your co-workers by asking your employer for voluntary benefits.
Other Excluded Illnesses
Aside from the short term disability preexisting condition qualifications, there are two other commonly used exclusions: addictions, and mental illnesses.
Any illnesses that are caused by an addiction to alcohol or drugs do not qualify. However illnesses caused by an addiction to a drug prescribed by your doctor may meet qualification guidelines. The policy holder may have to show that the drugs were taken as prescribed and not abused. Many prescription drugs have noted side effects which may cause a loss.
Losses caused by mental illnesses are typically not considered a qualifying condition. You may not qualify for benefits if you have been unable to work because of any mental or emotional disorder, psychosis, or neurosis. Many people with mental illnesses are prescribed strong drugs with negative side effects. Losses caused by these drugs may be a qualifying condition, per the above.
Every policy is written differently, so check your policy language carefully.
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