How do you apply for short-term disability benefits and get your claim approved quickly without delays or appeals?

Lack of coverage is the number one denial reason. Many people are unaware of the gaps until they experience an accident or illness that prevents them from working.

Therefore, the first step is figuring out whether you have coverage. You may be eligible under a private policy, a state plan covering temporary disabilities, Social Security addressing permanent conditions, or Worker’s Compensation dealing with on-the-job incidents.

Then, the second step is figuring out where to get the claim paperwork, how to fill it out, and what exclusions might interfere with an approval.

Apply for Private Short-Term Disability

You can apply for short-term disability benefits from private insurance only if you purchased a policy in advance. You cannot file a claim for coverage you do not own. In addition, you must meet the waiting period requirement in order to be eligible.

Many people mistakenly assume that their employer pays for this wage replacement plan for them or has a paid medical leave program. This is a dangerous assumption that kills approvals.

Claim Approvals

Apply for short-term disability benefits from private companies in the correct way so that you obtain a quick claim approval. Avoid needless delays, denials, and appeals by completing the paperwork right the first time. In addition, be aware of common policy exclusions that may affect your eligibility.

Waiting Period

The insurance company will not approve your short-term disability claim until you satisfy two types of waiting periods. Both the industry and consumers use two terms that mean almost the same thing. This creates much confusion, which we hope to clear up.

  1. Waiting periods can refer to the time during which the policy will not honor claims arising from pre-existing health conditions. For example, a 12/12 pre-existing condition exclusion has two main components.
    1. Sickness or physical disorder for which you were treated, received medical advice or had taken medication within 12 months before the effective date
    2. You become disabled during the first 12 months the policy is in force because of the pre-existing condition
  2. Elimination period can refer to the length of time that must elapse after the disability begins until the insured is eligible for any monthly payments. Check your policy to determine the length of time you must hold on.

Qualifying Conditions

The insurance company is also more likely to approve your short-term disability benefits application when a qualifying medical condition causes your loss of income. Every policy will have key definitions that determine eligibility for claim payments.

  • Total Disability
    • Unable to perform all the duties of your regular occupation
    • Not engaged in any other employment for wage or profit
    • Under the regular and appropriate care of a doctor
  • Eligible Sickness
    • Infection, disease or other abnormal medical condition
    • Diagnosed after the coverage effective date
    • Causes a loss of income while the policy is in force
    • Not specifically excluded
  • Covered Accidents
    • Occurs after the effective date
    • Happens while the policy is in force
    • Causes a loss of income
    • Is not listed or excluded by name

Follow Instructions

Following instructions is the best way to ensure a short-term disability claim approval. You, the applicant are in control of how you complete the online or paper-based form. Your money will arrive in the mail or via direct deposit much faster when you provide everything the insurance company needs to make their decision the first time.

Do not cut corners or skip steps. Avoid the most common mistake (3 signatures).

  1. Applicant must sign the claimant statement
  2. A doctor must sign the physician statement
  3. The authorized person must sign employer statement

Pregnancy Leave

Apply for pregnancy disability benefits in three stages – provided you purchased a private short-term policy at least three months prior to conception. The coverage start date is the most important approval tip.

Women taking leave from work may file claims for three different qualifying reasons.

  1. Complications of pregnancy can prevent mom from working before her due date. The doctor’s note on the form must describe the medical reason you cannot perform the primary duties of your full-time occupation. “Bed rest” or “high-risk” descriptions are insufficient.
  2. Recovery from childbirth is a covered medical condition for policies acquired through employment – not as an individual. Many insurance companies provide an express claim form that only requires a doctor statement on the delivery method (Vaginal or Cesarean).
  3. Postpartum disorders that delay your maternity leave return to work often require a continuing disability claim form. A continuation means a new reason is preventing you from working. You do not have to satisfy a new elimination period.

Apply for Temporary Disability

People sometimes find that applying for temporary disability benefits bears fruit more frequently because the federal or state government requires most workers to enroll. These public programs cover more people. However, many holes remain.

  • State disability exists in only 6 out of 50 possible regions
  • Social Security covers permanent conditions only
  • Worker’s Compensation addresses occupational incidents only

Social Security

Applying for temporary disability benefits through Social Security (SSDI) is unlikely to bear fruit. Your doctor must declare that your medical condition will prevent you from working at any job for at least 12 months in order to qualify.

File an SSDI claim if you expect your medical condition to meet the eligibility criteria (last more than 12 months). Make an appointment at your local Social Security Disability Determination office. Most states have at least one office in each county.

State Plans

You can apply for state temporary disability benefits if you work in one of 5 states (soon to be 6) that have a mandatory program covering non-occupational incidents. Non-occupational means that your illness or injury occurred while you were off-the-job.

In these 5 states, far more people are eligible to file a claim because of the requirement that nearly everyone enrolls. However, people working in one of the 45 states without a program will not qualify.

California

Apply for California State Disability Insurance (SDI) benefits by filing your claim online. Visit the SDI web portal to start your application. You will need to complete these basic steps.

  1. Gather required information
  2. Complete a one-time registration
  3. Log in and file a new claim
  4. Contact your physician to submit medical certification
  5. EDD will contact you with the status

Hawaii

Apply for Hawaii Temporary Disability Insurance (HI-TDI) by completing and filing paper-based form. Hawaii does not have an online system as of early 2019 because the law requires private companies to fulfill coverage. The Department of Labor provides these instructions.

  1. Notify your employer immediately
  2. Ask for Form TDI-45
  3. Complete Part A (Claimant’s Statement)
  4. Take the form to your physician to certify Part C
  5. Have your employer complete Part B
  6. Mail the form to your employer’s insurance company

New Jersey

Apply for New Jersey Temporary Disability Insurance (NJ-TDI) by visiting the MyLeaveBenefits.nj.gov web portal. There you can file your claim online or via a paper-based form. Follow these basic instructions when completing the application.

  • Personal identifying information
  • Key dates regarding your situation
    • When you became disabled
    • Emergency treatment or hospitalizations
    • Worked for any employers in the last year
    • Paid time off or other help you received
    • Expect to recover and return to work
  • Medical certification from your doctor
  • Statement from employer confirming
    • When you worked
    • How much you earned

New York

Apply for New York State Short-Term Disability (NYS-STD) by contacting your employer first. The NYS law requires employers to purchase a private policy on behalf of all workers. Therefore, only your employer can tell you where to mail the universal claim form for a decision.

Download the appropriate universal form. Then mail or fax the paperwork to the insurance company selected by your employer.

  • DB-450 if you were actively employed
  • B-405.5 if you depend on prayer for healing
  • C-3 if you suffered an on-the-job accident or illness
  • DB-300 if you were unemployed

Rhode Island

Apply for Rhode Island Temporary Disability Insurance (RI-TDI) benefits by visiting the Department of Labor and Training website. There, you have the option of filing an online claim, downloading the paper-based form, or calling to request delivery of an application by mail.

The RI program has several unique features and requirements. Therefore, expect to provide additional information beyond the typical identifying information, doctor note, and employment and income verification.

  • The RI-TDI plan covers the disabled and caregivers
    • Illness, injury, surgery
    • Care of a seriously ill family member
    • Bond with child
  • The number of dependents determines payment rate

Washington State

You can apply for Washington State Paid Family & Medical Leave (WA-PFML) benefits beginning in January of 2020. The program covers temporary disabilities for up to 12 weeks in addition to workers taking time off to care for a sick family member.

You will be able to set up a customer account with the Employment Security Department to apply for and manage your claim. This portal is still under development at the publication date of this article.

Workers Compensation

Apply for temporary disability benefits for occupational issues through the Worker’s Compensation insurance provider of your employer. Occupational accidents and illnesses occur while you are on-the-job.

All 50 states require employers to pay for Worker’s Compensation coverage for all employees. Therefore, more people qualify for coverage associated with on-the-job injuries and sicknesses. File a claim with the insurance company to see if you qualify for any of these bits of help.

  • Partial wage replacement
    • Temporary disability
    • Permanent disability
  • Medical care
  • Rehabilitation services