People often confuse important qualifying terms together. The language you use matters.
First, you must apply to purchase a short-term disability insurance policy – unless your state mandates the program.
Residents have coverage automatically in five states for non-occupational losses, and in all fifty states for occupational incidents.
Then, you qualify to file a claim for short-term benefits – if you do not have a preexisting medical condition. Learn how to manage the process online and appeal a possible declination.
Applying for a Short-Term Disability Policy
The number one qualifying factor is that people must apply for (purchase) a short-term disability insurance policy before becoming sick, hurt, or pregnant.
- The new policy application form will ask medical questions. Insurance companies will decline applicants for two main reasons.
- Currently unable to work
- Major health issues ongoing
- If issued, the new policy will exclude coverage for any pre-existing health condition. This exclusion lasts for at least 12 months.
- Minor health issues ongoing
Applying for Maternity Leave
Applying for short-term disability for maternity leave involves several important qualifiers. You must purchase the insurance at the right time, and in the right place – if you can.
Apply for short-term disability at least three months before conception in order to ensure that you qualify for maternity leave coverage. Avoid two common exclusions.
- New plans will not cover pre-existing conditions for at least 12 months
- Normal childbirth must occur 9 months after the effective date
- Many babies deliver preterm
- Expect delays when enrolling at work
Applying while pregnant allows many women to purchase a policy. If approved, they receive coverage for future losses due to accidents, illnesses, and the next time she conceives. However, it does not cover her current baby.
Apply At Work
Applying for short-term disability at work offers women better maternity leave payouts. Only worksite-sourced plans offer the most popular feature: coverage for mom’s recovery from labor and delivery.
- Vaginal birth: six weeks
- Cesarean delivery: eight weeks
However, enrolling at work is not always an option and less convenient when it is.
Many employers do not offer a program. Women can ask them to offer a voluntary option. Employees pay the premium themselves. Therefore, the request is not difficult.
You cannot sign up any time you please. Many employers restrict access to an annual open enrollment period. Women looking to start shortly before getting pregnant often face two difficult choices.
- Delay becoming pregnant until the next annual open enrollment
- Buy long before getting pregnant to ensure getting in
Apply Without Employer
Applying for short-term disability outside of an employer is much easier. People can connect directly with an agent licensed in their state, and buy an individual policy at any time of the year.
However, the maternity leave payouts are not as good.
Individual plans bought outside of employers do not cover mom’s recovery from labor and delivery. They often pay when medical complications require her to leave her job before her due date. Therefore, the plan still has enormous value. It is a strong alternative.
The language around applying for temporary disability can mean very different things. Once again, people frequently interchange terms creating confusion. Therefore, we offer key requirements for the two most common uses.
- Five states offer temporary disability covering off-the-job accidents and sicknesses (non-occupational). The states are California, Hawaii, New Jersey, New York, and Rhode Island. They require most private and state government employers to enroll all employees automatically.
- All fifty states have Worker’s Compensation, which provides temporary disability for on-the-job injuries and illnesses (occupational). They require most private and government employers to cover all employees automatically.
You do not need to purchase these two temporary disability insurance program types proactively. They automatically have coverage and can skip directly to filing a claim.
Filing a Claim for Short-Term Disability Benefits
Only people who already have a plan in force are eligible to file a claim for short-term disability benefits. Of course, this is true only if they are unable to perform the duties of their full-time occupation because of a covered medical condition.
In other words, you must be unable to work because you are sick or hurt. Nothing happens in advance. A doctor must indicate the medical reason that you cannot perform your job duties.
Find information about online claims, reasons, duration, denials, and appeals. FMLA, Worker’s Compensation, and Unemployment operate differently.
Most issuing companies and government agencies support an online short-term disability claims process. The first step is to register on the web-based policyholder portal. Use this virtual resource to manage the entire filing process and expedite a final decision.
- Download the form for your doctor and employer to complete
- Communicate electronically with the case manager
- Monitor the progression status
Become familiar with the valid reasons to file a short-term disability claim. Read the contract exclusion language carefully. Knowledge can help you shorten the processing time and avoid causing a denial.
It is easier to list what is not covered. These are examples of ineligible causes.
- Addiction to alcohol or drugs
- Aviation not as a fare-paying passenger
- Giving birth during the first nine months of the effective date
- While committing a felony
- Having a pre-existing condition
- Mental and emotional disorders
- Driving motor vehicles in a race
- Participating in professional sports
- Injuring yourself intentionally
- Acts of war
- Serving in the armed forces
You may need to file a short-term disability claims appeal letter if the carrier denies the benefit.
Carriers often deny claims because of insufficient documentation. Many people fail to follow instructions properly. Carefully review your denial letter to understand the reasons for why the company turned down the entitlement.
An attorney can help file the appeal letter, but make sure that your documentation is correct first. Attorneys do not litigate free. Compare their legal charges with the expected amount you are seeking to recoup. In many cases, the total case amounts are too small to warrant legal expenses.
It is very difficult to estimate the average length of a short-term disability claim. Both the policy features and the medical reasons determine the duration of payments.
Two features embedded in each policy can dictate how long the claim will last.
- Elimination period describes how long the person must wait before payments begin. The most common options are 7 days, 14, day, and 30 days.
- Benefit period defines the maximum duration of any single case. The most common options are 6 months, 12 months, and 24 months.
The medical reason driving a loss also factors into the duration of claims.
- Women recover from normal labor and delivery within 8 weeks. In this scenario, the elimination period drives the result.
- Anyone suffering from a dread disease such as cancer could miss years of work. In this scenario, the benefit period determines the outcome.
Many people can file for short-term disability claims multiple times in one year. There is no stated limit. Anyone can submit an online request for each instance after they return to the job, and then need to stop working again.
Policy definitions determine whether to start a new elimination and benefit period. You may reach the benefit period maximum after two, three, four, or more claims for a recurrent disability.
- Recurrent means you returned to work then had to stop for the same or related medical condition. The company will treat this as continuous.
- New means you returned to work and then had to stop because of an unrelated condition. The company will restart the benefit period.
Filing for short-term disability while on FMLA does not guarantee that the company will honor the claim. The person must be on leave due to his or her own serious medical condition.
The Family Medical Leave Act is a federal regulation with unique qualifying reasons. It is not insurance. Sometimes the two programs intersect, but often they do not.
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Filing for unemployment during and after a short-term disability has many outcomes.
- During a temporary disability, people do not meet the basic unemployment eligibility criteria in all 50 states. They are not physically able or available to work.
- After a temporary disability, some individuals may qualify to collect unemployment. Research the laws in your state regarding good cause reasons for quitting. Some specify that an employee’s own medical condition will suffice. More allow the care of a sick family member.
- Personnel covered by family leave laws have job security. They remain employed and are ineligible during and after a temporary disability – as long as the employment safeguards last.
You often cannot claim temporary disability and worker’s compensation for the same loss.
- The two programs are mutually exclusive. The former pays for non-occupational incidents, while the latter pays for occupational accidents.
- Very few individuals have coverage for both. Worker’s compensation is very common since most states make it mandatory. However, the reverse is true of off-the-job conditions.