STD, or Short Term Disability, is a type of insurance benefit offered by many employers. It is designed to cover a portion of your income if you can’t work in your own occupation after becoming sick or injured. In most cases, it is worth the effort to apply for your short term benefits. Short Term Disability plans not only compensate for your lost pay, but is often a precursor to benefits under your long term disability plan.
The Benefits of Short Term Disability Insurance Plans are:
- Pays you a portion of your income after an injury or illness
- Kicks in after paid sick leave has run out
- It is not a loan
- Payments come from an insurance company and not your employer
- Paves the way for Long Term Disability benefits, if you are still unable to work
- Affordability of most plans
When Should I apply for Short Term Disability?
In order to be able to use your employer’s short term disability plan, you need to first be enrolled for coverage. You cannot enroll in the plan after you become ill or hurt, in the same way that you cannot buy car insurance after an auto accident and expect to be covered. Some employers will cover the cost of disability insurance, in other instances you will pay for it, and sometimes it is a cost which is shared between employer and employee. As with all insurance, the costlier the plan, the better coverage you will have. If your job is offering disability policies, you will want to enroll at that point. Just like enrolling in a health insurance plan at work, there may be restrictions about minimum earnings or the length of time that you have been employed before you can apply for coverage. For example, some employers will only offer disability plans to full time employees and others will require that someone be with the company for a certain period of time before offering this benefit.
Assuming that you have enrolled in the employer sponsored plan, you can then file a short term disability claim when and if you need coverage.
What Restrictions are there in applying for Short Term Disability?
Keep in mind that Short Term Disability plans (and long term plans) are private policies that are governed by the contract that policyholders have with the insurance company. They are private insurance companies such as Prudential, MetLife, Cigna, The Hartford, etc. In Illinois, employers are not required to provide disability coverage, but many do.
Short Term Disability Policies should not be confused with social security disability benefits or the Family Medical Leave Act (FMLA), which are run by the government. That being said, the benefits offered by most of these disability policies are still strictly regulated by federal law under ERISA, the Employee Retirement Income Security Act. Unfortunately, ERISA laws are not favorable to the individual and are heavily slanted towards favoring the insurance companies. This is why it is so important to seek legal advice immediately from a local attorney if your STD benefits are denied.
Since these are group insurance policies underwritten by private companies, your short term disability benefits are dependent upon the terms written in the policy. Generally, the plans have the following restrictions in place:
- Work related injuries are not covered. If you were hurt at work, you would look to worker’s compensation laws instead.
- Pre-Existing Conditions not covered by short term disability plans.
- Some conditions are not covered. For example, recovery from cesarean (C- section) births are covered under some plans, but not others.
- Short Term Disability plans are not as comprehensive as the Family Medical Leave Act, in that a person will not be covered if they need time off to take care of a sick family member or to adopt a child.
- Sick leave has to be taken first before using short term disability
- Medical Documentation Required. Having documented medical support is absolutely critical, in that a doctor will need to back up your own claims that you are not well enough to work. If your doctor tells you that you can go back to work, even if you disagree, you will have an uphill battle with the insurance company. Like any insurance, payment on your claims are never automatic.
If I Decide to Apply for Short Term Disability, what is Covered?
Coverage under short term disability is defined by the terms of your actual policy. Generally speaking, most STD plans provide coverage for the first three to six months. Some plans will run even longer. The plans typically pay you between 40 and 60 percent of the income that you were earning before you had to stop working. This percentage often increases once you shift over to a long term disability plan, assuming that you are still unable to work once the short term disability coverage runs out.
What is the Likelihood of my Short Term Disability Benefits Going Through?
The likelihood of the insurance company actually paying out on your short term disability depends on many factors. As mentioned, the terms of your policy will dictate. Assuming that you qualify for benefits and your doctor agrees that you are not well enough to return to work yet, your policy should theoretically cover you. Sometimes, insurance companies will deny people their benefits instead of just paying them. The reasons for these denials of short term benefits are many and not all of them are legally justifiable.
Do I need a lawyer for help with my Short Term Disability?
You should consider calling a lawyer for help with your Short Term Disability under these circumstances:
- You participated in your employer’s group disability plan and
- You cannot work in your occupation because of an illness or injury that will last longer than your sick leave and
- Your medical condition wasn’t caused by your job and
- Your doctor agrees with you that you cannot return to work yet and
- You received a denial letter from the insurance company giving you the right to appeal the decision. Do not try to appeal on your own. At the very least, claim a free book which will explain a lot more about why you should rely on the help of an attorney if you’ve been denied short or long term disability benefits.
Short Term Disability policies do have their limitations but as with any insurance, good coverage is the key to being prepared, should you need to use it.