People applying for disability benefits in Washington State often learn the hard way of the gaps in government-mandated coverage.

First, the public plan covering temporary disabilities runs out after twelve weeks. People who remain unable to work are out of luck.

Second, two government-required plans for permanent disabilities either address occupational incidents only or have a five-month waiting period and low approval odds.

Buy a policy from a private insurance company before the need arises to avoid falling through these cracks. If you arrived here too late, learn how to file a claim for four public programs that could help – with limitations.

Applying for Temporary Disability

People in Washington State have three options when applying for short-term disability benefits resulting from an off-the-job accident or illness. Temporary means you expect to return to work in more than one week but less than one year.

  1. A public program that pays claims for twelve weeks after a one week elimination period
  2. Private plans that may continue claim payments for a year or longer if you remain unable to work after the public program runs out
  3. Unemployment compensation may help people who recover from their injury or illness but lost their job in the interim

Private Plan

Applying for short-term disability from a private insurance company in Washington State is a two-step process. First, you must buy a policy before you have a pre-existing condition. Only then can you file an off-the-job claim for benefits after the state program runs out after week thirteen.

New Policy

You must complete a new short-term disability policy application to buy coverage, which will include questions about your medical and earnings history. The insurance company will review your answers and determine if you are healthy enough to qualify.

Request a quote to start the process. An agent licensed in Washington State may contact you to review cost figures for various feature combinations.

  • Elimination period: choose a 3-month waiting period to coincide with the end date of the state plan (12 weeks) as the most affordable option (see below)
  • Benefit period: determines how long the policy makes claim payments while you are unable to work
  • Monthly Amount: up to 2/3 of your regular earnings subject to a cap of $6,500 per month

Filing Claim

You can file a claim for short-term disability benefits provided you began coverage before becoming sick, hurt, or pregnant. If so, visit the website of the private company that issued your policy to download the claim form.

Complete the paperwork and obtain three signatures before submitting the documentation to the insurance company for review.

  1. Policyholder to verify personal details
  2. Doctor to confirm the medical reason you cannot perform work duties
  3. Employer to validate that they are no longer paying wages

Government Program

Most individuals can apply for short-term disability benefits via the Washington State government-run program called Paid Family and Medical Leave (PFML). The PFML provides partial income replacement payments when a covered person is unable to work because of a severe injury or illness that is non-occupational.

Covered Workers

Most people have this coverage for temporary disabilities because the state government requires employers to collect and disperse SDI premiums for all workers. However, several groups are exempt.

  • Federal employees
  • Businesses located on tribal lands
  • Self-employed individuals who did not opt into a voluntary plan
  • Union members subject to older collective bargaining agreements

Amounts

The state-run temporary disability program (PFML) replaces up to 90% of income with a maximum weekly amount of $1,000 beginning in January 2020. The claim checks can continue for up to 12 weeks in a year – after meeting a one week elimination period. Low earners receive the 90% level, while higher earners get back a smaller percent of their pre-incident income.

Application

Filing a claim for state-mandated temporary disability benefits is simple. Visit the government website and follow the steps outlined there.

  1. Give your employer 30-days written notice if possible
  2. Have proof of your identity ready
  3. Complete the Certification of a Serious Health Condition form
  4. Submit the documentation via the online application portal

Unemployment

Many individuals could be eligible to claim unemployment benefits after their short-term disability ends. Some people must quit their jobs, while others lose theirs through no fault of their own – because they were unable to perform work duties for health reasons.

Washington State unemployment law supports applications from workers who quit their job for a good cause reason, which includes becoming sick or disabled.[1] Of course, you become eligible only after you meet the three main criteria.

  1. Physically able to work
  2. Available for duty
  3. Actively seeking a new job

Applying for Permanent Disability

People working in Washington State have three places to turn when applying for permanent disability benefits. Here, permanent means you expect to be out of work for at least one year, or the medical condition will result in death.

  1. Public Social Security disability that covers non-occupational impairments that prevent you from performing any work
  2. Private long-term disability plans which address off-the-job impairments that stop you from pursuing your previous job duties
  3. State-required Workers Compensation that covers occupational incidents that prevent you from

Long-Term

Individuals who purchased a long-term disability fare best after they suffer a loss that keeps them out of work for an extended period.

  • Monthly benefits are often much higher than SSDI
  • Claim payments can last to age 65 or longer

Private long-term disability policies bridge the two gaps in public plans. First, they address off-the-job accidents and illnesses. Then, the “Own Occupation” legal definition leads to a higher rate of claim approvals.

Apply for benefits by contacting the private insurance company that issued the policy. Follow the instructions carefully, and consider hiring an attorney if the company denies the claim.

Social Security

Washington State residents who apply for Social Security disability to deal with a permanent off-the-job impairment (lasting at least one year or longer) have three counter-balancing concerns when it comes to approvals. The issues create another gap that private plans can fill – if you act in time.

  1. Most people have this coverage in force because the federal government forces workers to contribute to the system. [2]
    1. Social Security Disability Income (SSDI) pays claims to you and some family members if you worked long enough and paid FICA taxes
    2. Supplemental Security Income (SSI) covers disabled adults and children who have limited earnings and resources
  2. The application approval rates are meager (average of 67% of initial claims denied) because the “Any Occupation” legal standard is tough to meet.
    1. You can no longer work in your previous occupation
    2. You cannot adjust to new work
  3. The five-month waiting period means that even immediately approved people could face a two-month gap in benefits after the state plan runs out.

Apply for benefits by calling 1-800-772-1213, visiting www.ssa.gov/disability, or going to a social security office near you.

Occupational

Worker’s Compensation is a state-mandated disability insurance program that covers occupational (off-the-job) accidents and illness. The Washington State Department of Labor & Industries[3] and self-insured employers can process claims for a variety of possible benefits.

  • Medical care
  • Travel expense reimbursement
  • Wage replacement
  • Return to work help
  • Permanent partial disability
  • Pensions for permanent total disability
  • Vocational training

Affected employees have multiple options when applying for Worker’s Compensation benefits.

  • Online via the L&I FileFast tool
  • By phone: 1-877-561-FILE (3453)
  • At your doctor’s office (complete Report of Accident form)
  • Contact self-insured employer’s personnel department

[1] WA Employment Security Department

[2] SSA.gov

[3] WA State Department of Labor & Industries