Short-term disability insurance covers injuries and illnesses that satisfy your policy’s definition of a qualifying medical condition, which typically has five components.
- The loss of income starts after the policy effective date
- The medical event occurs while the policy is in force
- The policy does not explicitly exclude the condition
- The medical problem causes a loss of income
- The insured is under the care of a licensed physician
Learn how these five rules might apply to your situation – given more in-depth definitions found in most policies.
Disclaimer: only claims personnel can make benefits eligibility determinations at your insurance carrier. This article is for informational purposes only.
Short-Term Disability Qualifying Illnesses
Short-term disability insurance covers illnesses that satisfy your policy’s definition of a qualifying medical condition. Your coverage disclosure statement might read as follows.
“A covered sickness is an infection, disease or other abnormal medical condition, which is diagnosed after the coverage effective date (not pre-existing), causes a loss of income while the policy is in force, and is not specifically excluded.”
Learn how this rule applies with several examples.
Short-term disability covers maternity leave as a qualifying illness when the coverage begins before conception. Mothers can frequently file claims under three sets of circumstances.
- Medical complications of pregnancy before birth
- Recovery from labor and delivery
- Postpartum health disorders (not depression)
Short-term disability does not cover paternity leave as a qualifying illness even though it causes a loss of income. The father is not under a doctor’s care during any part of the childbirth process.
You cannot use short-term disability to care for family members during paternity leave or any other time for a similar reason. The insured person is physically capable of working. This rule holds for adoption and the care of sick children and parents.
Short-term disability sometimes covers elective surgery as a qualifying illness, provided the contract language does not explicitly exclude the type of operative procedure.
Cosmetic surgeries reshape healthy tissue to improve one’s appearance and are not a medically necessary reason. Most policies will exclude lost income during recovery from any cosmetic procedure – even though you are under a doctor’s care.
Short-term disability often covers Coronavirus as a qualifying illness because the severe breathing issues, profound aches, and lack of energy cause a loss of income and require medical care from a doctor.
However, the insurance company could deny your short-term disability claim for Covid for other reasons typical in most policies.
You can use short-term disability for Covid, provided you cannot work past the elimination period stated in your policy. The elimination period defines how quickly benefits begin.
Most people recover from Covid within weeks, sometimes before meeting the elimination period, which could last 7, 14, 30, 90, or 180 days.
You can get short-term disability for Long-Covid, provided your symptoms do not prevent you from working past the benefit period stated in your policy. The benefit period defines how long claim payments continue.
Many people suffer long Covid symptoms such as phenomena and high fevers for an extended time, possibly exceeding the benefit period, which could last 3, 6, 12, or 24 months.
Short-term disability does not cover Covid quarantine as a qualifying illness even though it causes a loss of income. The insured person does not need a doctor when they are not sick.
An asymptomatic person might have to isolate themselves during quarantine after exposure to someone with the virus. You do not need medical care when you have no symptoms.
Short-term disability rarely covers mental health problems because they do not fit the definition of a qualifying illness. Stress, anxiety, depression, and panic attacks are not diseases, infections, or other medical problems.
Also, most policies will exclude mental health issues expressly, even though they cause a loss of income and often require care from a licensed physician. The language might read as follows.
“We will not pay benefits for losses that are caused by or are the result of your having a mental or emotional disease or disorder of any kind, including psychosis and mood disorders.”
Short-term disability covers many acute diseases as they fit neatly into the definition of a qualifying illness, and they are most likely to cause a total loss of income.
You must meet the total disability definition on your initial claim to be eligible for benefits, and your disclosure statement might read as follows.
“Being totally disabled means you are unable to perform all the material and substantial duties of your regular occupation.”
For example, some of these acute sicknesses might fall into this category.
|Appendicitis||Heart Attack||Kidney Stones|
|Pneumonia||Stroke||Urinary Tract Infection|
Short-term disability covers many chronic diseases as a qualifying illness, provided they first meet the total disability definition (see above) during the initial claim. People with chronic sicknesses often take intermittent leave as their symptoms wax and wane.
Fortunately, the criteria for subsequent claims are laxer and do not require you to meet a new elimination or waiting period.
- Partial: work part-time
- Recurrent: stop working, return, then stop again
For example, some of these chronic sicknesses might fit into this category.
|High Blood Pressure||Herniated Disks||Lyme Disease|
|Migraine Headaches||Rheumatoid Arthritis||Sciatica|
Short-Term Disability Qualifying Injuries
Short-term disability insurance covers specific accidental injuries that meet the definition of a qualifying medical condition. Consult your policy documents. You might find legal language similar to this statement.
“A covered accident occurs after the effective date while the policy is in force, causes a loss of income, and is not listed or excluded by name in the contract.”
Short-term disability covers most broken bones deemed qualifying injuries. The broken ankle, leg, arm, rib, jaw, or collarbone most occur while the policy is in force and cause a loss of income.
The list of covered injuries does not stop at broken bones. For example, each of these wounds might be deemed an eligible reason per the criteria.
|Dismembered Fingers, Toes, Hands, or Feet||Deep Lacerations|
|Torn Ligaments, Tendons, Cartilage, or Rotator Cuff||Dislocated Joints|
|Head Trauma||Severe Burns|
Short-term disability might cover a car accident provided you suffer a qualifying injury (see above). The wound occurs while the coverage is in force, causes a loss of income, and requires the care of a medical professional.
Of course, every rule has exceptions. Below are three examples.
First, it does not matter whether you have a car accident or trip walking down the steps, as long as the injury occurs off-the-job. File a claim with Worker’s Compensation if you suffer an occupational incident.
Second, your policy should cover injuries sustained in car accidents, not excluded, such as riding or driving in a motor vehicle race or stunt. Other exemptions include the following.
- Participating in a felony, riot, or insurrection
- Trying to commit suicide or injure yourself
- Being exposed to an act of war
- Serving in the armed forces
- Operating any private aircraft (no published schedule)
- Working at an illegal job
- Participating in a sport for compensation
Third, your auto insurance might include personal injury protection, which pays your hospital bills and replaces lost wages. Your policy might coordinate benefits with this coverage and limit total claims to 70% of your earnings.