Short-term disability benefits are part of the Massachusetts Paid Family Leave program. You could receive partial wage replacement if you suffer a severe health problem unconnected to your occupation.

Find directions for the application process.

Meanwhile, Temporary Disability Insurance (TDI) offers partial wage replacement for on-the-job accidents and illnesses.

So, why might you buy individual disability insurance before your next injury or illness?  Your benefits could run out after only twenty weeks, and the amount you receive might not be enough to cover everyday bills.

MA PFL & Short-Term Disability

The Commonwealth of Massachusetts will begin offering short-term disability benefits on January 1, 2021, under the Paid Family Leave umbrella. Most workers automatically have off-the-job coverage, with a few notable exceptions.

  • Residents who commute out of state to work in Rhode Island, New York, Connecticut, Vermont, or New Hampshire
  • Employees of the federal government, municipalities, school districts, housing authorities, and other exempt employers
  • Self-employed small business owners who did not opt-in

Application

Expect a three-step process when completing the new Massachusetts short-term disability application. Follow the instructions carefully to avoid delays in processing your claim, and direct all correspondence to the Department of Family and Medical Leave (DFML).

  1. Verify your identity by uploading government-issued documents such as a driver license, passport, or resident card
  2. Complete the Certification of Serious Health Condition form (PFML-FORM-0001-Cert-SHC-V1.0.0)
  3. Enter your employment information, including the Federal Employment Identification Number (FEIN) from your current job

Amount

The amount that short-term disability pays in Massachusetts depends on your income. The benefit is progressive: high earners receive a lower percentage of wage replacement, and a per-week maximum kicks in for people earning more than $78,000 annually.

Annual IncomeWeekly BenefitPercent

$26,000

$400

80%

$52,000

$708

71%

$78,000

$850

57%

$104,000

$850

43%

You calculate the exact amount by inputting earnings from the last four quarters.

Length

The short-term disability benefits last up to twenty weeks under the Massachusetts PFL. If you remain disabled beyond this point, you can submit a new application with a new certification.

However, you may have to wait thirty-two weeks to resume claim payments as the twenty-week maximum applies to rolling calendar years. Then, by the time you re-apply, your earnings for the last four quarters could be closer to zero.

Pregnancy

Short-term disability may cover three pregnancy-related medical conditions under the Massachusetts PFML program, plus two different connected reasons.

  1. Complications of pregnancy that occur before your due date
  2. Recovery from labor and delivery during childbirth
  3. Postpartum medical disorders that delay return to work

Each of these maternity leave scenarios occurs frequently and could consume the full twenty weeks of benefits. Fortunately, two related PFML claim reasons can extend the total time off by another six weeks if needed.

  1. Baby bonding time
  2. Care for a premature infant

MassHealth

MassHealth members participate in two possible programs that address medical expenses: doctor visits, prescription drugs, hospital stays, and long-term care for seniors.

  1. Medicaid offers healthcare to low-income families and their children
  2. Children’s Health Insurance Plans (CHIP) provides healthcare for kids when their parents earn too much to qualify for Medicaid

However, MassHealth does not offer short-term disability. Low-income wage earners would have to apply under the Paid Family Leave program (if employed).

TDI

Be careful not to confuse the Massachusetts PFL program with the other form of mandatory Temporary Disability Insurance (TDI), as the two programs are very different.

Workers Compensation TDI applies to people suffering from on-the-job accidents rather than non-occupational injuries and illnesses. The benefits are also better because they pay for medical care and rehabilitation and wage replacement that can last far longer.

Contact your employer for details about the mandatory coverage they hold for temporary losses occurring on-the-job. Apply through the private company that issued the policy.

Individual Disability Insurance MA

In Massachusetts, individual disability insurance is less critical than before now that the state requires coverage for temporary losses. However, two big holes remain that you might want to fill before your next accident or diagnosis from a doctor.

Remember, you cannot purchase new coverage once you have a pre-existing health condition. Therefore, you want to take proactive steps.

Individual Long-Term

Individual long-term disability insurance could fill the Massachusetts PFL program’s giant hole: the twenty-week benefit duration. For example, a person out of work for one year might face thirty-two weeks with zero dollars coming in.

Request an individual disability insurance quote with a six month elimination period. With this configuration, the private policy might make claim payments shortly after the PFL benefits run out. This way, you do not face extended gaps without money coming in.

Financial assistance while waiting for Social Security approval is not reliable for many people because few resources exist. Plus, the Social Security programs pay very little (about $1,200 per month on average) once granted. Having a long-term policy in force addresses both concerns.

Individual Short-Term

Individual short-term disability insurance can plug the other big hole in the Massachusetts PFL program. The limited monthly benefit affects people who earn too much money.

The weekly maximum of $850 takes effect above $78,000 of annualized income. Anyone earning above this amount will face a pay cut of at least 43%.

Annual IncomeBenefit %Pay Cut %

$78,000

57%

43%

$104,000

43%

57%

$156,000

29%

71%

Therefore, high-income earners might consider buying an individual plan to boost their coverage if they cannot sustain a significant cut in pay for twenty weeks.

Final Thoughts

Massachusetts recently became just the seventh state with mandatory short-term disability coverage. The Paid Family Leave program includes partial wage replacement when an employee must stop working because of a severe health condition.

The primary advantage of government-required coverage is that people can tap into the benefit when they need it, without buying a policy in advance. Let’s face it. We all think that bad things only happen to other people – until they affect us.

Therefore, purchase individual coverage if you need a higher level of income replacement or you want claim payments to last more than twenty weeks.  Sign up proactively before your next accident or unwelcome diagnosis.