People in Texas ask how to apply for short-term disability for different reasons.
Some Texans may be interested in knowing where to purchase a policy to safeguard their income.
Other workers in the Lone Star State may wonder where to submit a claim to receive benefits that can replace their lost wages.
Texas has no state-mandated program covering off-the-job accidents or illnesses. To file a claim for benefits, you must have a policy beforehand.
However, since your income will be lower, you may be eligible for benefits to help you cut expenses. Additionally, you may be able to receive assistance from Social Security Disability Insurance or Workers’ Compensation.
Texas STD Claim Filing Applications
You cannot apply for short-term disability benefits by filing a claim unless you enrolled in a policy before becoming sick, hurt, or pregnant. Texas does not mandate a program covering off-the-job (non-occupational) accidents and illnesses.
- Texas STD Claim Filing Applications
- Texas STD New Policy Applications
- TX Short-Term Disability Requirements
- TX Short-Term Disability Cost
- TX Short-Term Disability Qualifications
- TX Short-Term Disability Laws
- TX Temporary Disability Insurance (Occupational)
If you do not have coverage, you cannot file a short-term disability claim to replace lost income. Fortunately, you may be eligible for other state-supported benefits based on your lower projected income.
Government money for bills and personal use could be available to reduce expenses. Low-income families can present estimated future earnings on alternative benefit applications. These programs could keep your household afloat while recovering from an accident or sickness.
- Your Texas Benefits provides an application point for several options.
- Supplemental Nutrition Assistance (SNAP)
- Temporary Assistance for Needy Families (TANF)
- Medicaid for adults with children
- Children’s Health Insurance Program (CHIP)
- Women Infants & Children (WIC)
- Comprehensive Energy Assistance Program (CEAP)
- Low-Income Water Assistance Program (LIWAP)
- Section 8 Housing Choice Vouchers
Suppose you do not have a short-term disability policy. In that case, you can file a claim for benefits through SSDI, funded through FICA payroll taxes and mandated by the federal government.
However, the Texas state-administered benefits are lacking and difficult to get.
- SSDI covers disabilities lasting twelve months or longer. You become ineligible by returning to work before then.
- They use a strict Any-Occupation definition. You are ineligible if you can perform any substantial gainful activity.
- You must wait five months before benefits begin. Many live check-to-check while working and have no savings.
- Most families experience a massive pay cut because the average monthly SSDI benefit is only $1,400.
Apply for SSDI benefits online at SSA.gov. A Social Security office near your home will administer your case. If you are deaf or hard of hearing, call TTY 1-800-325-0778.
|Social Security Offices||Phone Number|
|10824 N. Central Expressway Dallas, TX 75231||(866) 572-2492|
|8989 Lakes At 610 Drive Houston, TX 77054||(866) 593-2846|
|1029 Camino La Costa Austin, TX 78752||(866) 627-6991|
|1060 Guadalupe St Kerrville, TX 78028||(877) 895-0043|
|2010 N State Hwy 360 Grand Prairie, TX 75050||(855) 722-3499|
Texas workers who purchased a short-term disability policy before getting sick, hurt, or pregnant can apply for benefits. File a claim with the private insurance company that issued your policy.
Find the phone number and website URL in your files. Download the claim form and follow the instructions carefully to avoid unnecessary delays.
Complete the document and submit it for underwriting review. If approved, the insurer will begin sending checks per the terms outlined in your policy.
Texas STD New Policy Applications
Texas does not mandate state short-term disability insurance covering non-occupational illnesses and injuries. Therefore, workers must get coverage before getting sick, hurt, or pregnant. There are three avenues, ordered by preference.
|Plan Type||Individual (outside of employers)||Voluntary (employee-paid)||Group (employer-paid)|
|New Policy Application||Must complete||Must complete||Automatic enrollment|
|Monthly Premiums||Highest||Lower||Lowest ($0)|
|Underwriting||Strict: more policy denials||Lenient: fewer policy denials||Guaranteed issue: no policy denials|
Not every Texas employer offers short-term disability insurance as an employee benefit. You can still purchase coverage alone if your workplace does not provide an option.
Individual short-term disability, not through employers, is available. Find a licensed agent to take your application by requesting a quote online. However, these plans have several drawbacks.
- Premiums will be higher
- Underwriting criteria are stricter
- Benefits are less generous
Self-employed business owners in Texas can sometimes purchase short-term disability insurance with lower premiums, more lenient underwriting, and more generous benefits.
The self-employed can get short-term disability with these superior terms if they work as independent contractors. Several insurance companies will issue worksite plans to 1099 employees, provided the premiums are payroll deducted.
Many private employers offer short-term disability insurance as an employee benefit. Below are several large companies in Texas offering a plan.
|Texas Health Resources||Arlington||X|
Many government employees can get short-term disability insurance at work. An agency, department, or university might offer a voluntary or group (employer-paid) program.
State government workers can buy short-term disability insurance through a voluntary plan called the Texas Income Protection Plan (TIPP).
Group Benefits Program (GBP)-eligible employees can enroll twice: during their first 31 days without evidence of insurability or during special or annual enrollment with proof of good health.
Purchase TIPP coverage by following these steps.
- Log in to your ERS account at ers.texas.gov
- Select the short-term disability option
- Answer the questions about your health (if needed)
- Submit for approval by Guardian Life Insurance (the underwriter)
File a claim for TIPP benefits within 90 days if you lose income due to an off-the-job accident or illness. Follow these steps.
- Access the online self-service option
- Call TIPP Customer Care (855) 604-6230
- Complete the claim form mailed to your home
- Return the paperwork within ten business days
The Texas Employee Retirement System administers TIPP for state agencies and higher education personnel. You should be able to participate if you work for one of these entities.
10 Largest TX State Agencies by Employees
|Health and Human Services Commission||Workforce Commission|
|Department of Criminal Justice||Office of the Attorney General|
|Department of Transportation||Department of State Health Services|
|Department of Family and Protective Services||Parks and Wildlife Department|
|Department of Public Safety||Commission on Environmental Quality|
Some municipal government employees in Texas can get short-term disability insurance through their city employer.
Many public school employees in Texas, including female teachers seeking maternity leave benefits, can get short-term disability at work.
|Independent School District||Voluntary||Employer-Paid||Neither|
Many federal government employees work in Texas at the Departments of Agriculture, Veterans Affairs, Homeland Security, Justice, Interior, Treasury, Transportation, and many more.
Federal employees can enroll in a voluntary short-term disability plan by contacting a licensed insurance agent outside their agency and arranging to pay the premiums through payroll allotment.
Postal workers are federal employees.
Universities & Colleges
Many Texas university and college faculty and staff can get short-term disability insurance at their workplace. The state-supported higher education institutions can offer TIPP (covered above).
|University of Houston||X|
|Texas Tech University||X|
|University of Texas *||X|
* The state university system offers a TIPP alternative at all campus locations: Arlington, Austin, Dallas, El Paso, Nacogdoches (Stephen F. Austin), Permian Basin, Rio Grande Valley, San Antonio, and Tyler.
|Lone Star College||X|
TX Short-Term Disability Requirements
The primary short-term disability requirement in Texas is buying an insurance policy before getting sick, hurt, or pregnant to protect your income. No state law forces enrollment for programs covering off-the-job (non-occupational) accidents or illnesses.
Buy short-term disability in Texas before you have a pre-existing health condition. The pre-existing condition requirement might affect your coverage when purchasing a policy and filing a benefits claim.
If you have a pre-existing condition, short-term disability coverage begins twelve months after the policy’s effective date. However, many people with pre-existing health conditions are ineligible for coverage.
You must be healthy enough to get the coverage. When completing the new policy application, expect the insurance agent to ask detailed questions about your medical history.
Women must purchase short-term disability for pregnancy before conception. Texas maternity leave laws provide for unpaid job-protected time off for parents, making this requirement crucial for new mothers.
If you purchase short-term disability while pregnant, two policy exclusions will eliminate maternity leave benefits associated with your current baby.
- The policy will exclude pregnancy-related disabilities during the first twelve months after the effective date as a pre-existing condition.
- The policy will not pay benefits for any losses caused by your giving birth due to normal pregnancy within nine months after the effective date.
TX Short-Term Disability Cost
Short-term disability insurance policies in Texas offer unique feature combinations that policyholders can choose based on their impact on monthly premiums.
Our short-term disability cost calculator illustrates how the benefit period, monthly amount, and elimination period affect monthly premiums. Meanwhile, factors that remain constant may also impact rates.
- Tobacco use
- Job role
- Industry classification
Short-term disability benefits last the lesser of your recovery time (when a doctor clears your return to work) or the benefit period stated in the policy.
Employees choose the benefit period when buying the coverage. The longer the policy pays claims, the higher the monthly premium costs.
|Monthly Premiums||Benefit Period|
The maximum that short-term disability pays is two-thirds of income or a monthly limit (typically $7,500), whichever is lower.
Employees choose the monthly amount when enrolling in the coverage. Higher monthly amounts result in costlier monthly premiums.
|Monthly Premiums||Monthly Amount|
Short-term disability benefits start after satisfying the policy’s elimination period, which means the time when claims are not payable.
Employees choose the elimination period when purchasing the coverage. The more quickly benefits begin, the higher the monthly premium costs.
|Monthly Premiums||Elimination Period (Days)|
|Lowest||90 accident/90 sickness|
|Middle||30 accident/30 sickness|
|Highest||0 accident/ 7 sickness|
Short-term disability has income tax implications because it insures wages. Your choice of payment method impacts the upfront monthly cost or the downstream claim payment.
- The benefits are income-taxable when filing a claim if you pay the premiums with pre-tax payroll deductions. In this case, you save money upfront.
- The benefits are tax-free when filing a claim if you pay the premiums with after-tax dollars. In this instance, you save money when you need it most.
TX Short-Term Disability Qualifications
Short-term disability insurance in Texas covers injuries and illnesses that satisfy your insurance policy’s definition of a qualifying medical condition causing lost income. The policyholder must be under the regular care of a licensed physician.
Qualifying accidental injuries for short-term disability must meet specific criteria. Check your policy for statements like these.
- Occurs after the effective date and while the policy is in force
- Is of a type listed in the policy schedule
- Is not excluded by name or description
- While committing a crime
- While driving in a race
- Practicing or playing a professional sport
- Injuring yourself intentionally
- Flying in an unscheduled airplane
- Being exposed to an act of war
Qualifying sicknesses for short-term disability must meet similar standards. Check your policy for statements like these.
- Is diagnosed after the policy effective date
- Is of a type listed in the policy schedule
- Causes a loss beginning while the policy is in force
- Is not excluded by name or description
- Addiction to drugs or alcohol
- Having a mental or emotional disease
- Having a pre-existing health condition
Surgery often qualifies for short-term disability benefits, provided the operation meets the criteria for illnesses and accidents noted above.
Claim payments work differently for surgery based on the type of operation and your recovery time.
- The surgery must be medically necessary. Cosmetic procedures reshaping healthy tissue to improve appearance do not qualify.
- The recovery time must exceed the elimination period. Wisdom tooth removal would not meet the threshold, but a hysterectomy or knee replacement might.
Mental health problems rarely qualify for short-term disability. Mood or thought disorders are not medical conditions.
To receive short-term disability benefits for mental health issues, a policyholder must have group coverage rather than an individual policy. Employer-paid plans sometimes include these benefits, while employee-paid programs typically do not.
An employee-paid individual policy might have an exclusion similar to the statement, “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.”
A loss of income from your regular occupation is often a qualifying condition for short-term disability. Many policies contain an Own-Occupation definition, which is more lenient than an Any-Occupation standard.
Read your insurance policy and look for the disability definition. An Own-Occupation standard might read as follows; “Totally disabled means you cannot perform all of the material and substantial duties of your regular occupation.”
TX Short-Term Disability Laws
Several Texas laws affect workers dealing with a short-term disability (STD). None of these regulations provide income replacement, but they do address job security and other workplace concerns.
The Family Medical Leave Act (FMLA) is a federal short-term disability law safeguarding Texas workers. FMLA provides twelve weeks of unpaid job-protected time off for eligible employees working for a covered employer.
You can use FMLA and STD together for your serious medical condition. However, you would be ineligible to take both concurrently to care for a sick family member.
Paid Family Leave
Insurance companies can now offer short-term disability riders or stand-alone policies that provide benefits for additional reasons under Texas Voluntary Paid Family Leave (HB 1996), a new law.
In specific situations, paid family leave insurance can replace all or part of an employee’s income.
- The birth or adoption of a child
- The placement of a foster child
- Care of a family member with a severe health condition
You can choose whether or not to contribute to the premiums. The state does not mandate payroll deductions for the paid family leave program.
Texas law does not permit workers to collect unemployment while on short-term disability. The two programs have mutually exclusive criteria.
You cannot file for unemployment if you are off for medical reasons because you fail the primary test: being physically able to work. However, you might be eligible after your recovery.
Texas law provides an exception for workers who quit their jobs. The legal language reads, “You are not disqualified if you left work because of a medically verified illness of the individual” (injury, disability, pregnancy).
TX Temporary Disability Insurance (Occupational)
In Texas, Workers’ Compensation provides temporary disability insurance covering on-the-job (occupational) accidents and illnesses. State law mandates the coverage, meaning employees do not need to enroll proactively.
Texas employees must not purchase temporary disability to file a claim application. By law, employers must furnish Worker’s Compensation Insurance for most personnel, with some exceptions.
File a Worker’s Compensation claim by reporting the injury or illness to your employer within 30 days of the incident or onset. Contact the Texas Division of Workers’ Compensation Claims & Customer Services at 800-252-7031, option 1 for help completing the paperwork.
Send a completed DWC Form-041 (Employee’s Claim for Compensation for a Work-Related Injury or Occupational Disease) to protect your rights.
Division of Workers’ Compensation
PO Box 12050
Austin, TX 78711
You can fax the form to DWC at 512-804-4378.
If you lost income from multiple jobs, complete DWC Form 003ME (Employee’s Multiple Employer Wage Statement). Return the form to the insurance carrier and the DWC.
Texas Workers’ Compensation provides temporary disability insurance and other benefits that can help you replace lost income and recover your health more quickly.
- Temporary income benefits
- 70-75% pre-disability weekly wage
- Starting after seven days of missed work
- It ends at the shortest of when you reach Clinical Maximum Medical Improvement or after 104 weeks.
- Impairment Income Benefits
- Permanent damage to your body
- 70% of pre-disability weekly wage
- Do not depend on your ability to work
- Three weeks per percentage point of impairment
- Supplemental Income Benefits
- Begin after impairment benefits end
- Apply if you cannot work
- Apply if you are paid 80% less
- Requires impairment rating of 15% +
- Participate in a vocational rehabilitation program
- Reapply every three months
- Lifetime Income Benefits
- 75% of pre-disability income with a 3% inflation adjustment
- No pre-defined end date
- Medical Benefits
- Pay for medical treatment of workplace injury
- Covers reasonable and necessary care