Does the Commonwealth of Pennsylvania offer short-term disability insurance? How long do the benefits last, and how much does it pay?
You determine the answer to the last set of questions because the state does not have a mandatory program for off-the-job (non-occupational) accidents, illnesses, and pregnancy.
To qualify, each individual has to first buy a new policy by showing evidence of good health. Only then can you file a claim for benefits for covered medical conditions.
On the other hand, PA laws open the door to related programs with mandatory participation that might help. You do not have to enroll in these in advance but do have to fit specific criteria.
Short-Term Disability in PA
Individuals employed in Pennsylvania need to purchase short-term disability insurance from a private company before becoming sick, hurt, or pregnant. The state does not have a mandatory program.
Once you have a pre-existing condition, it will be tough to qualify for coverage or file a claim for temporary non-occupational benefits and meet the eligibility criteria in each phase.
How to Apply
People employed in Pennsylvania face a two-step short-term disability application process. You must buy a new policy before filing a claim form if you expect to return to work in less than twelve months.
Apply for short-term disability through Social Security if you expect your medical condition to prevent you from performing any work for at least twelve months.
Your job is to compile the medical evidence supporting your claim for benefits.
- What are your illnesses, injuries, or conditions?
- When did they begin?
- How do they limit your activities?
- What did medical tests show?
- What treatment did you receive?
Request an individual short-term disability quote to start the process. An agent licensed in PA may contact you to review premium rates based on three feature choices.
- The benefit period determines how long claim payments last: 3, 6, 12, or 24 months
- The benefit amount determines how much the policy will pay monthly: up to 2/3 salary subject to a $7,500 limit
- The elimination period determines how quickly claim payments begin: 0,1,2,3,6, or 12 weeks
The agent can help you complete a new policy application and submit it to the insurance company for review. You must show evidence of good health to qualify.
How it Works
Short-term disability works the same way in Pennsylvania as it does across the country. An individual policy may replace a portion of income when you cannot perform your job duties due to a covered medical reason – with noted exceptions.
Pennsylvania maternity leave laws do not include income replacement during your time off. Therefore, buying short-term disability before conception is the primary alternative.
However, the place where you enroll and the type of policy can impact how the coverage works.
- Medical complications of pregnancy before your due date
- All plan types may include
- Recovery from labor and delivery after normal childbirth (two outcomes)
- Individual plans bought outside of employers do not cover
- Personal and group plans obtained at the worksite include coverage
- Vaginal delivery: 6 weeks
- C-section birth: 8 weeks
- Postpartum disorders that delay your return
- All plan types address postpartum medical issues
- Only group plans include postpartum depression
Short-term disability might cover your surgery. However, the coverage can work differently in two common scenarios.
- New policies will not cover surgery for a pre-existing health condition until the coverage has been in force for at least twelve months (knee replacement)
- All plans will not pay for cosmetic surgery, which enhances your appearance and is not medically necessary (breast enhancement)
Short-term disability may cover illnesses such as COVID-19. The Coronavirus pandemic provides an excellent opportunity to illustrate how the coverage works.
- Only the covered person qualifies to file claims when sick with COVID-19, not other family members requiring care or supervision at home during a lockdown
- Many people recover from the Coronavirus very quickly and can return to the job well before the elimination period ends
- People who have to quarantine to avoid infecting others may be ineligible if they can perform job duties from home
Short-term disability claims payments may be income taxable. The way it works depends on how you fund the premium and varies for federal and PA income taxes.
- Federal income tax is due in proportion to any premiums funded by the employer or paid by the wage-earner using pre-tax payroll deductions
- PA income taxes are not due on any third party disability claims payments
PA Short-Term Disability Laws
The most critical Pennsylvania short-term disability insurance laws pertain to whether the state requires residents or employees to maintain a specific coverage type. You cannot file a claim unless you have a policy already in force.
The Commonwealth does not have a legal mandate for programs covering temporary income losses caused by off-the-job (non-occupational) injuries and illnesses.
However, the state does require related types of coverage.
The most frequently enacted short-term disability law in Pennsylvania pertains to out-of-state commuters – in both directions. Two neighboring states have legal mandates that apply based on where you work rather than where you live.
- New Jersey has a required program. NJ residents commuting into Chester, Philadelphia, Levittown, Bethlehem, Easton, or Stroudsburg to the job lose the benefits. Conversely, PA residents traveling in the opposite direction gain.
- New York has a mandatory program. NY residents commuting into Scranton, Sayre, Bradford, or Erie to their job lose benefits, while PA residents traveling in the opposite direction gain.
However, commuters to and from Delaware, Maryland, West Virginia, and Ohio find themselves in the same boat. These states also do not have mandatory coverage.
Pennsylvania unemployment compensation law does not permit individuals with a temporary disability to file a claim. Three universal provisions rule out qualifying for unemployment due to medical reasons.
- Physically able to work
- Available for employment
- Actively seeking a new job
However, related statutes make it possible to file a claim and win approval after recovering from your injury or illness and are ready to resume activities. You must have informed your employer of limitations before quitting due to health reasons.
”If the employer fails to offer suitable work, the claimant may be eligible.”
The Commonwealth of Pennsylvania administers two Social Security disability programs that cover non-occupational (off-the-job) losses. By law, most residents fund the premiums automatically through mandatory FICA payroll taxes.
Therefore, almost everyone qualifies to file a claim without having to buy coverage in advance. However, two gaping holes remain.
- Social Security does not cover temporary disabilities; your doctor must indicate that your health condition will last more than twelve months
- Lengthy approval times make it difficult to survive, and only about 40% of applicants ultimately qualify
Pennsylvania law requires employers to purchase Workers Compensation on behalf of employees, which provides temporary disability benefits for occupational (off-the-job) accidents and sicknesses.
The State Workers Insurance Fund (SWIF) oversees this mandatory coverage, which does far more than cover temporary income losses.
- Services rendered by physicians or other health care providers
- Reasonable surgical and medical care
- Hospital treatment and supplies
- Prescription medicines and supplies
- Orthopedic appliances and supplies
The Commonwealth of Pennsylvania offers short-term disability to state government employees. However, there is no legal requirement for taxpayers to fund the premiums on behalf of public personnel.
State government wage-earners have the option to enroll and pay the premiums themselves via payroll deductions. Group policies like these typically have discounted rates, laxer underwriting standards, and better benefits for childbirth.
Therefore, state employees should sign up at work.