Paying the out-of-pocket expenses (deductible, copayments, etc.) for any surgical procedure can prove expensive. But the financial consequence can prove devastating when combined with lost income while out of work during your recovery.
Getting disability income benefits for a short time after surgery can help you comfortably rest and recover. The extra cash relieves some monetary anxiety when your regular bills come due for payment.
People covered by short-term disability issued by a private insurance company often fare the best because many operative procedures are covered conditions.
Meanwhile, the remainder could get lucky when they apply for government-sponsored disability benefits after their surgery – if available and qualified
How to Apply for Disability After Surgery
The secret to applying for disability after surgery is to find a program that will honor claims for a short time during your recovery. The devil is always in the details, and many people will not be eligible.
If you need surgery but can’t afford to miss work because you do not qualify for income benefits, other financial assistance programs might offer more hope.
Some patients might get Social Security disability briefly after surgery because most people have the coverage. The government forces you to pay premiums with every paycheck via FICA taxes.
You can apply for temporary disability through Social Security, but the recovery or underlying health condition must extend to at least twelve months to qualify. You are ineligible if you can perform any work within the first year.
- A bowel resection disability might qualify if follow-up radiation and chemotherapy made it impossible to work for twelve months or longer
- A knee replacement disability would not trigger claim payments because the average recovery period of six months fails the eligibility criteria
Other people can get state disability for a brief period after surgery if they work in one of the seven that require the benefit. Those working in the forty-three other states must look elsewhere.
Apply for state-mandated temporary disability benefits while recovering if you work in California, Hawaii, Massachusetts, New Jersey, New York, Rhode Island, or Washington.
Others can get Worker’s Compensation disability for a short time after surgery if they injure themselves while working on the job. All states require employers to carry an insurance policy on behalf of employees, so most people have the coverage already in force.
Apply for Workers’ Compensation temporary disability by contacting your employer immediately after becoming sick or injured while on the job. They should provide the appropriate documents to file your claim during recovery.
Many more can get disability briefly after surgery, provided they bought a supplemental insurance program before getting sick or hurt off the job. Many employers offer this benefit and allow employees to pay the premiums through a payroll deduction.
Supplemental short-term disability insurance fills the gaps noted above. It covers non-occupational accidents and sicknesses that last less than one year for people working in the forty-three states without a mandatory program.
Apply for supplemental disability benefits after your surgery by filing a claim with the insurance company that issued the policy. Follow the instructions carefully to avoid unnecessary delays.
How Does Short-Term Disability Work for Surgery
Many patients wonder how short-term disability insurance works for surgery because they cannot work and earn an income during their brief recovery period. One guiding principle provides your answer.
Short-term disability covers surgery (qualifying condition) when medically necessary: needed to prevent, diagnose, or treat an illness, injury, disease, or symptoms.
Buying short-term disability before surgery is unlikely to work in your favor, even when medically necessary. You could fail the underwriting criteria for the new policy application or the claim for benefits.
Short-term disability pre-existing condition clauses could cause problems when buying a new policy before surgery at two checkpoints.
- The new policy application includes medical history questions, and the insurance company will decline to issue a new policy if a doctor has recommended surgery
- Most policies exclude benefits (claims) for operative procedures due to a pre-existing health condition within twelve months of the effective date
Short-term disability covers elective surgery when medically necessary – elective means scheduled in advance at a time convenient to the patient and doctor. Of course, you cannot have a pre-existing health condition clause or run afoul of other exclusions that lead to denials.
Short-term disability benefits can be denied for two reasons relating to elective surgery: the legal definition and the elimination period.
Out of Work
Short-term disability covers elective surgery only when you are out of work during recovery, per doctor’s orders. The legal definition might state, “You cannot perform all the material and substantial duties of your regular occupation.”
Contrast how this rule might work for two people undergoing shoulder surgery to repair a torn rotator cuff.
- Management employees might be out of work for six weeks after the shoulder surgery because limited arm movement does not interfere with job duties
- Plumbers could be out of work for six months after rotator cuff surgery because they need to lift their arms continuously as part of their job duties
Short-term disability covers elective surgery when you are out of work beyond the elimination period stated in your contract, which could be 0,7,14, 30, 60, 90, or 180 days. Compare your elimination period to the average recovery time for these elective surgeries.
|1 – 6 Months||ACL|
|3 – 6 Weeks||Bariatric Weight Loss|
|6 – 8 Weeks||Bunion Surgery|
|1 – 3 Months||Carpal Tunnel|
|1 – 6 Weeks||Gallbladder Removal|
|3 – 6 Weeks||Hernia Repair|
|6 Weeks||Total Hysterectomy|
|3 Months||Total Knee Replacement|
|3 Months||Total Hip Replacement|
|12 Weeks||Open Heart (Bypass)|
|1 Week||Wisdom Teeth Removal|
You cannot use short-term disability for cosmetic surgery because the insurance policies do not cover procedures that reshape healthy tissue to improve appearance and symmetry. The operations are not medically necessary.
Avoid taking out cosmetic surgery loans because it will prove challenging to repay the lender while out of work without disability income benefits. Have enough money to fund the operation and recovery for these procedures.
- Tummy Tuck (Abdominoplasty)
- Vaginal Rejuvenation (Labiaplasty)
- Breast Enhancement (Mammoplasty)
- Liposuction (Lipectomy)
- Face-lift (Rhytidectomy)
- Brazilian Butt Lift (BBL Fat Transfer)
- Mommy Makeover
Short-term disability frequently covers plastic surgery because procedures that reconstruct facial and body defects caused by congenital deformities, accidents, or illnesses are often medically necessary.
You can get plastic surgery for free because your health insurance should also cover most expenses for these operations that correct defects or medical problems.
- Excess Skin Removal (Panniculectomy): rashes and infections
- Breast Reduction (Mammaplasty): back pain
- Nose Job (Rhinoplasty or Septoplasty): compromised breathing