The most critical lesson about how short-term disability insurance works in Texas boils down to two sentences.

First, you must complete a new policy application before becoming sick, hurt, or pregnant because the state does not mandate the coverage.  

Second, you cannot file a claim for benefits unless you have coverage already in force.

The only automatic coverage that people have address occupational losses (Workers Compensation) or maladies that last one year or longer (Social Security).

Therefore, you might want to take proactive steps to protect your income if you lack the savings to withstand six months of lost wages because of an off-the-job accident, illness, or pregnancy.

Individual Short-Term Disability Texas

People often need to buy individual short-term disability insurance because Texas does not mandate a program. Employees in public and private sectors must take proactive steps to cover non-occupational (off-the-job) accidents and illnesses.

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Application Steps

Most individuals in Texas will need to complete two possible short-term disability application steps. You must buy a policy before you can file a claim for benefits.

New Policy

Request a short-term disability quote to buy a new policy – provided that you do not have a pre-existing condition. The insurance company will reject your application if you have a poor health history.

An insurance agent licensed in Texas may contact you to help you complete a new policy application. Be prepared to answer questions about your income, work history, and health. Once complete, the agent will submit the form to the insurance company for underwriting review and possible approval.

Filing Claims

Apply for short-term disability benefits in Texas by filing a claim with the insurance company that issued your policy. Of course, you must have the coverage already in force to qualify for benefits.

Download the claim form and follow the instructions carefully to avoid delays and possible rejections. Keep in mind that most companies require three signatures.

  1. Applicant attesting the information is accurate
  2. Doctor verifying the medical reason you cannot work
  3. Employer confirming they are no longer paying wages

Qualifying Conditions

In general, short-term disability qualifying conditions in Texas will fit into several broad categories.

  1. Occurred while off-the-job (non-occupational)
  2. Causes a loss of income while the policy is in force
  3. Not listed or excluded by name in the contract

Also, three distinct coverage types can address qualifying conditions differently.

  1. Private plans bought outside of employers
  2. Personal coverage purchased at work but owned by individuals
  3. Group policies paid by employers and owned by the employer

Pregnancy

Texas maternity leave laws do not include paid time off for parents. Therefore, buying short-term disability before conception could be a critical step for women planning to have a baby: a new policy will not cover pre-existing pregnancies.

  • Medical complications of pregnancy before your due date
    • All plan types may include as a qualifying condition
  • Recovery from labor and delivery after normal childbirth (two outcomes)
    • Private 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 to work
    • All plan types address postpartum medical issues
    • Only group plans include postpartum depression

Mental Health

Short-term disability in Texas works differently for mental health issues. In most cases, private and personal policies do not consider stress, anxiety, depression, or any other psychosis as a covered medical condition.

Only group policies might honor claims for mental health reasons. Read your policy contract carefully before filing a claim if you must stop working for your emotional, psychological, and social well-being.

Coronavirus

Short-term disability in Texas may cover non-occupational illnesses such as the coronavirus. People sidelined by COVID-19 help us illustrate how all the coverage types handle disease-related qualifying medical conditions.

  • You must have a policy already in force to file a claim
  • Only the covered person is eligible for benefits
  • Coronavirus symptoms must prevent you from working
  • The elimination period could exceed the typical recovery

Texas State Short-Term Disability

Texas state short-term disability insurance works similarly. You must purchase a policy before becoming sick, hurt, or pregnant before you can file a claim for non-occupational benefits lasting less than one year.  

However, the state mandates participation in two closely related programs (Workers Compensation and Social Security) that do not require proactive steps.

Unemployment

Collecting unemployment for medical reasons is not a substitute for short-term disability insurance – although Texas state law includes a loophole that applies after recovery.

You cannot file an unemployment claim while disabled because you fail the primary criteria: physically able to work and available for duty.

However, after recovering from your illness or injury, you might be eligible if you lost your job in the interim. Texas unemployment law reads, “you are not disqualified if you left work because of a medically verified illness of the individual” (injury, disability, pregnancy).

Social Security

Social Security does not provide temporary disability insurance – although the state administers the program in cooperation with the federal government.

Texas residents have automatic non-occupational coverage because they make required premium contributions through FICA taxes. However, Social Security disability has many holes.

  • Your doctor must expect your medical condition to last one year or longer
  • The average monthly amount of $1,064 barely covers living expenses
  • Surviving while waiting for disability approval is challenging
    • No temporary income benefits
    • Few alternatives for wage replacement
    • Some government help with bill payment

Temporary Disability

Temporary disability insurance covers occupational (on-the-job) accidents and illnesses through Workers Compensation. The State of Texas does not require employers to purchase a policy on behalf of all employees. However, most employers opt-in to limit legal liability.

Apply for temporary disability benefits by filing a claim with the Workers Compensation insurance company selected by your employer. If you work for a non-covered employer, an attorney can help you file a lawsuit to recoup lost wages and other damages.

State Employees

You must take steps to purchase group short-term disability before you have a pre-existing condition if you are a Texas state-government employee. The coverage is not automatic or mandated.

The Texas Income Protection Plan (TIPP) is a voluntary benefits offering available to state-government personnel who are members of the Employee Retirement System (ERS). The group policy includes a 30-day elimination period, and claims can continue for up to five months before benefits cease.

Group Benefits Plan (GBP) eligible workers can enroll in TIPP at work and fund the premiums through payroll deduction.

  • New employees can participate without evidence of insurability
  • Late entrants must show evidence of good health
  • The plan will not cover pre-existing conditions for six months

Teachers

The rules for short-term disability in Texas for teachers fall into a gray area. You still must buy a policy before you have a pre-existing condition. However, the place where you obtain the coverage varies.

Elementary and secondary school teachers are not state-government employees. They are often TRS members of (Teachers Retirement System of Texas), which does not offer a group plan, as does ERS.

Therefore, teachers can enroll in a group coverage only if offered through their local school system or union. Otherwise, they may need to buy private coverage as an individual.