What Is The Difference Between FMLA & Short-Term Disability?

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Employees frequently ask about short-term disability and the Family Medical Leave Act (FMLA) while sick, injured, pregnant, and unable to work or when they need to care for a family member.

The two workplace benefits are not the same.

Short-term disability is an insurance program that replaces a portion of income when the covered person cannot perform the duties of their full-time occupation.

The Family Medical Leave Act (FMLA) is a federal law that provides twelve weeks of unpaid job security for eligible employees working for covered employers.

Examine several comparison points to understand how the two vary but can work together harmoniously.

Short-Term Disability Versus FMLA

Comparing short-term disability versus FMLA can help you determine whether the two programs might support your time away from the job and how the benefits might work in your specific situation.

Table Of Contents
  1. Short-Term Disability Versus FMLA
  2. Short-Term Disability & FMLA Together

How to Apply

The answer to how you apply for benefits is the first critical distinction between FMLA and short-term disability. Employees have different sets of paperwork to complete and unique places to send the forms.

  • Apply for short-term disability benefits through your state (if mandatory where you work) or by contacting the private insurance company that issued your policy. Submit the completed claim form signed by your doctor to the state agency or administering organization for underwriting review.
  • Apply for FMLA by completing the appropriate forms. Submit the finalized paperwork to your employer, providing adequate notice of your intentions to take a leave of absence when possible. Your HR department should be able to assist you with the process.

FMLA Disability Pay

The level of pay you might receive is the primary distinction between FMLA versus short-term disability, as the two programs address starkly different issues.

  • You do not get paid while on FMLA because federal law does not address income replacement. The regulation stipulates that covered employers must grant eligible employees twelve weeks of job-protected time off.
  • The amount short-term disability pays for an employee’s medical condition depends on three policy features for employees that have coverage already in force through their state or a private insurance company.
    • Elimination Period
    • Percentage of income
    • Monthly benefit limit
  • The amount state-based Paid Family Leave programs pay employees to care for sick family members (where applicable) also depends on a percentage of income versus monthly limit calculation.

Who Qualifies

The issue of who qualifies is another crucial distinction between FMLA and short-term disability. The criteria for the two programs are vastly different: one often requires proactive steps years before the need arises.

  • The #1 reason short-term disability benefits are denied is lack of coverage. Only seven states have mandatory programs with automatic enrollment. Employees working in the forty-three other regions must sign up for a policy independently before getting sick, hurt, or pregnant.
  • Approximately 56% of workers automatically qualify for FMLA without signing up years before the need arises because it is a federal law applying nationwide.
    • Eligible Employees
      • 12+ months tenure with the employer
      • Logged 1,250 hours over 12 months
    • Covered Employers
      • Private-sector companies with 50 + employees within a 75-mile radius
      • All federal, state, and local government agencies
      • All public and private elementary and secondary schools

What Qualifies

Finally, the question of what conditions qualify is another critical distinction between short-term disability versus FMLA. Both cover severe medical problems that prevent you from working, but with a unique twist that affects too many people.

  • Short-term disability does not cover pre-existing conditions until one year after the effective date for employees purchasing policies through private insurance companies. Individuals working in one of the seven mandate states have automatic coverage and escape this pitfall.
  • FMLA covers pre-existing medical conditions with no waiting period, provided the person worked for the same employer for twelve consecutive months before needing to take time away from the job.

Maternity Leave

The issue of short-term disability versus FMLA for maternity leave provides an ideal opportunity to illustrate several critical points already covered while offering the perfect segue to the next major topic: taking the two together.

  • Your ability to get short-term disability approved while pregnant often has two interpretations depending on the mother’s situation.
    • Buying a new policy while pregnant is possible, but you will not be approved for maternity leave benefits until one year after the coverage effective date.
    • Under three common scenarios, applying for maternity leave benefits results in approval for mothers with coverage in force before conception.
      • Pregnancy disability before birth
      • Recovery from labor and delivery
      • Post-partum medical complications
  • FMLA explicitly covers a broader set of maternity leave scenarios for eligible employees working for covered employers.
    • The mothers disabling medical condition
      • Pregnancy disability before birth
      • Recovery from childbirth
      • Post-partum medical complications
    • Bonding with newborn, foster, or adopted child
    • Caring for a pre-mature infant after NICU discharge

As you will learn, you can sometimes take short-term disability and FMLA simultaneously during maternity leave.

  • Yes: when the mother cannot work because of her serious medical condition
  • No: bonding with her baby or caring for a sick infant born prematurely.

Short-Term Disability & FMLA Together

Employees can often get short-term disability and FMLA together but should be aware of the instances where they might not qualify to take advantage of both simultaneously.  

The two might run concurrently for an employee’s disability but not when caring for a sick family member or bonding with a newborn during maternity leave.

Employee Condition

Employees typically can get FMLA short-term disability at the same time when they need to take a leave of absence due to their serious medical condition. In this case, you can often take advantage of both programs together.

  • Short-term disability covers accidents and illnesses of the insured employee that meet five crucial criteria.
    • The loss of income starts after the policy’s 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
  • FMLA covers accidents and illnesses for eligible employees working for covered employers when a severe medical condition makes it impossible to continue working.

Family Care

Employees cannot get short-term disability and FMLA concurrently when caring for a family member with a severe health condition. In this case, you cannot take advantage of both programs together because the criteria are mutually exclusive.