What is a short term disability?
Short term disability benefits provide income replacement if you suffer from an injury or illness or undergo a medical procedure that temporarily prevents you from working. short term disability benefits can also bridge the gap while you wait to become eligible for long-term disability benefits. Short term disability benefits are typically sponsored by employers, but you can purchase individual policies of short term or mid-term disability insurance if your employer does not offer disability insurance, or as a supplement to your employer’s benefits.
Employer-sponsored short term disability benefits may be paid to you by a third-party insurance company or via your company payroll. If your short term disability benefits are paid via payroll, the plan may be “payroll practice” exempt from the federal ERISA statute and instead subject to state contract law. That distinction can have a dramatic impact on your rights and remedies should your short term disability claim be unfairly denied. If you are contemplating applying for short term disability benefits, it’s best to consult an experienced disability insurance benefits attorney beforehand to help you understand your rights and submit the strongest application possible.
How long do short term disability benefits last?
Most short term disability plans offered through an employer provide income replacement for a period of three to six months, though some plans/policies may provide for as little as one month or as much as a year of short term disability benefits or more. There is typically a waiting period of one to two weeks before benefits commence.
How much will you get paid when you go on short term disability?
short term disability benefits typically provide 50% to 70% income replacement, although some employers may provide 100% income replacement for all or part of the duration. Payments are typically made on a weekly or bi-weekly basis. Your employer’s plan may feature a “buy up” provision which allows you to receive a higher benefit amount, usually conditioned on passing underwriting and/or paying a higher premium. These buy-ups must be elected upon enrollment in the plan or during the annual open enrollment, and they may be subject to pre-existing condition limitations. Most short term disability plans include offset provisions that reduce the amount of your disability benefit by amounts received from third parties, including salary continuation, unemployment benefits, and third-party tort recoveries. Those offset provisions can give rise to overpayments even after you have stopped receiving short term disability benefits, so it’s best to disclose any deductible sources of income to your disability plan administrator and employer when they are received to avoid an overpayment situation.
What disabilities qualify for short term disability benefits?
Any disabling illness or injury can qualify you to receive short term disability benefits, as can childbirth, recovery from surgery, and other medical procedures that temporarily prevent you from working. Generally speaking, a disabling impairment is one that prevents you from performing the material duties of your occupation. Most short term disability plans utilize a subjective definition of “occupation,” meaning you are disabled if you are unable to perform your occupation as you performed it for your specific employer. Thus, if you are a social worker and were required to drive as part of your job, and you suffer a disability that prevents you from driving, you will be deemed to be “disabled” even if driving is not a material job duty of social workers in the local or national economy.
There may be plan provisions that exclude coverage for certain disabilities. For instance, if you become disabled less than a year after you became covered under the plan, your disability benefits may be reduced or denied if the disabling impairment was determined to be “pre-existing.” To determine if a disabling condition was pre-existing, your short term disability plan administrator will request medical and pharmacy records during the “lookback period” (usually the three to six month period before coverage began, though sometimes longer). The plan administrator will then look to see if you were diagnosed or received treatment or medication for the disabling impairment during the lookback period (if yes, the claim will likely be denied). Similarly, if you become disabled due to a self-inflicted injury, participation in a crime or riot, or are legally disabled due to the loss of a license, your disability may be excluded from coverage.
Know Your Rights
Did you know that one in four people will become disabled before reaching retirement age? Protect your income by enrolling in your employer’s short term and long-term disability plans. If you become disabled, or if your disability claim is denied, contact our team of experienced and compassionate disability insurance attorneys . We will fight to get you what you deserve.
Does This Apply to You?
Contact DeBofsky Sherman Casciari Reynolds P.C. for an attorney consultation. We will work with you to figure out your problem, and how we can help. Contact us today!
Reasons why short term disability benefit claims get denied
Short term disability claims may be denied due to a failure by you, your employer, or your doctor to timely submit paperwork, or if the paperwork submitted is deemed not to support the existence of a disabling impairment. Even if your doctors and employer support your disability claim, it may nonetheless be denied if a doctor or nurse hired by the disability plan reviews the medical evidence and provides an adverse report. Often, this is done without an examination, based on a review of records only. If your disability claim is denied for any of those reasons, or for other reasons, contact DeBofsky Sherman Casciari Reynolds P.C. for a free consultation to discuss your appeal rights.
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T. H. | Client
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