People often begin thinking about disability insurance after becoming unable to work because of a non-occupational accident or illness.

The State of North Carolina takes good care of its government workers in this regard, as public employees enjoy tax-payer funded long and short-term disability coverage.

On the other hand, the individuals who pay those taxes and work for private companies are less prepared. They must take proactive steps while healthy to safeguard their most valuable asset – their health and ability to earn a living.

Social Security disability covers most people, but can be hard to get, takes a long time, and does not pay much if approved. Therefore, buying extra coverage while healthy makes sense.

Short-Term Disability Insurance NC

Short-term disability insurance in North Carolina is a tale of haves and have nots. State and local government employees enjoy tax-payer funded coverage after becoming members of the Teachers’ and State Employees’ Retirement System (TSERS) or Optional Retirement Plan (ORP).

Meanwhile, the tax-payers who work in private industry often must fund the premiums themselves and take proactive steps. The state does not have a mandated program addressing work absences caused by temporary non-occupational medical conditions for them.

New Policy

Request a short-term disability insurance quote for individuals if you work for a private employer or are self-employed, and want to buy coverage. You must show evidence of good health to qualify.

An agent licensed in North Carolina may contact you to review premiums rates for several feature combinations and help you complete a new policy application.

  • Waiting period: how long before claim payments begin
  • Benefit period: how long payments continue while impaired
  • Benefit amount: how much money you receive each month

Filing Claim

Filing a short-term disability insurance claim in North Carolina requires that you have coverage in force before becoming sick, hurt, or pregnant. Options for financial assistance while on FMLA are minimal, which is why being proactive is so critical.

If you already have a policy, apply for benefits by contacting the issuing company or appropriate agency, and follow the instructions carefully to avoid delays.

TSERS and ORP members must complete and submit extensive paperwork.

  • Form 701 – benefit application request
  • Form 700 – employer statement
  • Form 703 – earnings report
  • Form 7A – medical review

Covering Pregnancy

Short-term disability covering pregnancy in North Carolina amplifies the coverage disparity between government employees and the tax-payers working in private industry who support them.

Most women in the public sector have automatic DIPNC coverage, which has a 60-day waiting period that precludes claim payments for ordinary maternity leave experiences. However, a paid parental leave program for government workers only provides eight weeks (56 days) at full pay.

Meanwhile, women working in the private industry must purchase a new policy before conception to avoid pre-existing condition exclusions. Those who act in time can enjoy partial income replacement for three typical claim reasons.

  • Complications of pregnancy cause lost work time before birth
  • Recovery from childbirth labor and delivery
  • Postpartum medical disorders delay mom’s return to the job

Covid-19

The Covid-19 pandemic is an excellent motivator for NC workers in private and government jobs to purchase a primary or supplemental short-term disability policy – because the awareness of our mortality is at an all-time high.

Once covered, you will have peace of mind regarding other temporary work absences brought about by pregnancy, accidents, and other illnesses, including cancer.

The median time from onset to clinical recovery for mild Coronavirus cases is approximately two weeks and is 3-6 weeks for patients with severe disease.[1] Therefore, having a policy with a brief elimination period is critical should you miss work due to Covid-19.

However, the coverage applies only to the affected individual. It does not cover the care of family members sick with Coronavirus, or childcare during school closures due to lockdowns.

Government Employees

State and local government employees enjoy automatic enrollment in the Disability Income Plan of North Carolina (DIPNC) at their agency or school’s expense. The policy covers temporary illnesses and accidental injuries that occur off-the-job, but with three holes.[2]

  1. At least one year of contributing retirement membership within the previous 36 calendar months
  2. After satisfying a 60-day waiting period before claim payments commence
  3. 50% income replacement level subject to a $3,000 monthly maximum

However, these same public employees have the option to purchase supplemental policies that fill these gaps: begin immediately as a new hire, have a briefer waiting period, and increase the level of monthly wage support.

Social Security Disability Insurance NC

Social Security provides two types of disability insurance that covers non-occupational medical conditions for North Carolina residents. Unfortunately, neither plan covers temporary losses (lasting less than one year).

  • Social Security Disability Income (SSDI) pays benefits to you and some family members if you worked long enough and paid FICA taxes
  • Supplemental Security Income (SSI) covers disabled adults and children who have limited earnings and resources

Besides, SSDI and SSI can take a long time for approval, the check size is rather small, and work rules limit how much you can earn. However, buying a private long-term policy proactively when healthy helps to avoid these problems.

Approval Timing

The qualifications for Social Security disability in North Carolina are no different than the rest of the country. The federal government sets the parameters, while local offices adjudicate claims following their instructions.[3]

The answer to how hard it is to get approved, and how long the process takes is different for every person because you must show that you cannot perform your old work duties, and cannot adjust to a new job.

  • Many people have clear-cut cases and present all the necessary documentation at the outset, and the Social Security Administration (SSA) could approve their initial application within 60 to 120 days (1/3)
  • Other applicants have marginal cases and or weal documentation and SSA denies their initial claim (70%) leading to a lengthy appeals process that could take years to result in approval (1/3)
    • Reconsideration by the NC DDS
    • Hearing by an administrative law judge
    • Review by the Appeals Council
    • Federal court review
  • Another segment of the population have medical conditions that do not meet the criteria, and SSA denies the initial application and any subsequent appeals (1/3)

On the other hand, private long-term disability policies often have a more lenient underwriting standard: the inability to work at your previous occupation.

Check Amount

The size of the monthly Social Security disability check in North Carolina is the same as the national average. In other words, you don’t get very much when you consider the cost of food, clothing, and shelter.

Men Women
Workers $1,293 $1,043
Widows $732 $535
Adult Children $755 $770

A private long-term disability policy, bought while healthy could boost the amount of the check that you get every month – and make it easier to afford basic needs.

Work Rules

Social Security encourages disability recipients in North Carolina to work as it does throughout the country. The government wants people to be gainfully employed rather than dependent on a meager monthly check.

Two incentive programs support this objective.

  • During Trial Work Periods (TWP) earnings can exceed the Substantial Gainful Activity (SGA) limit for nine months
    • $1,130 non-blind
    • $1,820 blind individual
  • During the following 3-year Extended Period of Eligibility (EPE) benefits are reduced only in the months you exceed the SGA amount

In other words, a non-blind male can supplement his average $1,293 disability check with work earnings of $1,129, for a total of $2,422 monthly, or $29,064 annually – without jeopardizing benefits.

Footnoted Sources:

[1] WHO-China Joint Mission on Coronavirus Disease

[2] NC Total Retirement Plans

[3] Statistical Report on SSDI