Understand Your Short Term Disability Coverage
Before you apply for Short Term Disability, its important that you understand your insurance coverage. If you are offered group disability coverage through your employer, contact your Plan The administrator or Human Resource staff to help understand the extent of the coverage, or consult your benefits booklet. In case your employer does provide this coverage, you will be required to make your claim through the group plan.
Although your employer does not offer short term disability coverage as part of their group plan, you may be eligible for Employment Insurance benefits. For more information on whether you qualify for EI, check out the government of Canadas website here.
Other elements of your coverage that are important to understanding are your coverage amounts, which relate to how much benefit you will receive and how often. You will also want to know when you will start receiving the benefit if the benefit is taxable, and if your plan covers the third party claims management service like the Disability Management Institute as do most plans at GroupHEALTH.
How Can I Take Advantages Of Short
There are several ways to take advantage of a short-term disability insurance program.
Filing A Claim For Sdi
You can file a claim online at the SDI Online page of EDD’s website or you can file Form DE 2501, Claim for Disability Insurance Benefits, which you can request be mailed to you from the EDD website. You have only 49 days from becoming disabled to file a claim. You’ll also need to ask your doctor to fill out a medical certificate of disability or register online and certify your disability online.
If the EDD approves your application for SDI benefits, you will be sent a notice of eligibility, which will include an estimate of your weekly benefit amount.
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Whats Not Covered By Short
- Disabilities that happen in the workplace. About 10% of disabilities happen within the workplace, and are covered separately by workers compensation.
- Long-term disability. Long-term disability insurance general covers any disabilities that last for 6+ months.
- Severe health conditions. Social Security Disability Insurance is available to US residents with severe health conditions who either havent worked or accrued enough credits to be eligible for employer-sponsored disability insurance.
Does Short Term Disability Cover Pregnancy And Maternity Leave
Maternity leave is one of the most common uses of short term disability insurance. Many policies pay benefits up to six weeks after a normal delivery. For a C-section, women may receive up to eight weeks of benefits.
Keep in mind that benefits are subject to the policyâs waiting period. If the policy has a seven-day waiting period, benefits start seven days following delivery.
Itâs also very important to understand that pregnancy is considered a pre-existing condition. That means if you were pregnant prior to signing up for coverage and your policy limits benefits for pre-existing conditions, you would receive limited or no benefits for pregnancy-related time off.
If there are complications resulting from the pregnancy or delivery, you may qualify for additional benefits, either before or after delivery. This will require certification from your doctor.
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How Does Employment Insurance Work With Short Term Disability
Employment Insurance is a federal benefit that operates very similarly to STD, providing income replacement in the event an accident, illness, or injury prevents you from working. If you become unable to work and have STD through an employer, your STD benefit will take priority over any EI benefits.
Since the coverages work very similarly, were often asked something along the lines of, Why should I have STD if EI already covers me?
While its true that EI offers similar coverage, there are several advantages to a STD plan over EI benefits. EI is not usually as comprehensive an employer-sponsored STD plan, often having longer waiting periods and lower weekly payments. Furthermore, EIs income replacement is taxable to the employee, whereas STD benefits, depending on plan design, are not. Both STD and LTD benefits can be set up as taxable to the employee or non-taxable to the employee .
Can You Still Get A Job After Surgery
Plus, you still could have a job. Unemployment benefits become an option after you recover from surgery because you now meet the first criteria you are now physically able to work. You may now be eligible if you are still out of work depending on the reason and state.
The most important part of this experience is to focus on your health and recovery so that you can return to work. The short-term disability payments will end once you resume work, but they can be a good source of income and allow for peace of mind during your recovery time.
Collecting Unemployment Most people will be unable to collect unemployment while they are out of work due to surgery. During your recovery, you do not meet any of the three universal eligibility criteria for unemployment compensation.
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After Confirming Your Coverage
Once you have confirmed your short-term disability coverage and have scheduled your surgery, inform your employer as soon as possible. This allows them to arrange for staffing coverage during your planned absence. Provide the HR department with a doctors note that indicates the estimated length of time you will need for recovery.
Work with your manager to make sure your leave has a smooth transition, as well as to arrange for any post-surgery accommodations you may need. Find out if your employer expects you to perform any work at home while recovering.
During the surgery, have a close friend or family member keep your HR department informed of your status. This will let them know if there is anything else they might need to do .
The HR benefits administrator should be able to advise you on when your paid time off terminates and your short-term disability period begins. They should be able to tell you when the coverage period ends as well. The HR staff may not be able to tell you exactly how much each check will be, but your disability benefits provider might.
Can My Job Fire Me For Having Surgery
Wrongful Termination due to a Medical Condition
The California Fair Employment and Housing Act makes it illegal for your employer to discriminate against you due to a medical condition or perceived medical condition. Discrimination can include any adverse employment action, including firing or termination.
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Keep All Papers And Documents Related To Your Disability Claim
If your disability claim is wrongfully delayed or denied, you may only get a different outcome by fighting back.
Keeping or retrieving copies of all correspondence between you and your insurer helps you to do that, and it helps us help you. Such documents can include, but are not limited to:
- Any correspondence to and from you and your insurer.
- Denial or delay letters.
- Notes and dates from as many phone and email conversations you had with your insureror any other relevant professionalrelating to the unreasonable delay, wrongful denial, or your administrative appeal. Always try to include information like the day, time, name, and title of the person you talked to, as well as any important information shared or discussed in the conversation.
Find what you can, make note of the documents you remember submitting but cant locate, and save everything moving forward.
What Are The Elimination Periods For Long
The most common elimination period for long-term disability is 90 days, but the exact terms of the elimination period will be specified in the policy. If short-term disability coverage is available, the effective waiting period before receiving benefits will be relatively short. When a short-term policy is not available, however, employees may have to wait several months with no income before qualifying for long-term benefits. Due to the longer elimination periods, many employees opt for a combination of short-term and long-term disability coverage.
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Why Consider Short Term Disability Coverage
If you were unable to work because you were injured or became too sick, would you be able to cover your living expenses and additional medical bills? For most people, the answer is no. Short-term disability helps protect a portion of your income while you are off work. The University offers comprehensive sick, vacation and leave time. However, most employees do not have enough time banked to cover their pay in the event of an extended medically necessary absence. Additionally, the policies offered are individual policies that do not off-set other income, making the policy an affordable option to insure your financial security.
Unlike workers compensation, short term disability insurance pays benefits for an injury or illness unrelated to your job
Success And Support Through The Whole Process
Our approach works:
- 64% of employees who participated in the program successfully returned to work.5
- The program helped avoid more than $15 million in direct claim costs and 125,000 lost workdays.5,6
But whatever their outcome, your employees will receive the same integrated support and continuous case management whether they return to work, extend their Short Term Disability or transition to Long Term Disability.
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Is Short Term Disability Insurance Taxable
The premiums you pay for short term disability insurance are not tax-deductible. However, any policy benefits you receive will be tax-free income. This is true whether youâre buying a group plan or your own individual policy.
If your employer pays the premiums without including the cost in your gross income, the policyâs benefits will be taxable income.
Consult a tax advisor with questions about the tax treatment of disability insurance premiums and benefits.
Seriously Do You Really Need To Understand Your Short
Heres the short answer: yes. While its not exactly a fun topic to think about, its important that you familiarize yourself with the details of your planso you dont have to get up to speed when you actually need the benefit.
However, wading through our own plan documents is a step that most of us skip. That informational booklet is immediately relegated to our desk drawer or filing cabinet.
Do you remember the first day you started your job? Its kind of a firestormyou cant focus well or often, says McDonald. So we dont spend a lot of time achieving clarity about the benefit in the beginning. We only acquire an understanding of it when we are in deep need of the benefit.
But particularly if you have an existing problem or condition, youre going to want to know the ins and outs of the benefit thats available to you.
Anybody who goes into a new job and has any kind of serious medical condition that could at some point in time render them unable to work, I think its a good idea to be able to see the actual short-term and long-term disability plan documents to see how they define disability and how they handle pre-existing conditions, adds Bartolic.
Ideally, youll never have to take advantage of your short-term disability benefits. But in the event that the unexpected happens, youll be glad that you took the time to understand whats offered to you. This explainer is a good place to start, but you also need to read through the details of your specific plan.
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Ways Employees Can Disqualify Themselves From Sdi
In some situations, employees can lose their eligibility for SDI benefits. Benefits are not available for an employee who:
- missed the doctor’s appointment that the EDD set up
- is unable to work as the result of a felony he or she committed
- is incarcerated after being convicted of a crime
- is receiving unemployment benefits
- is receiving sick leave that equals his or her full salary or regular wages
- is receiving paid family leave benefits, or
- is receiving workers’ comp payments that are higher than what the employee would receive from SDI.
You May Have More Options After Wrongful Disability Denials
- A false assertion that your disabling condition was pre-existing and does not qualify for benefits under your policy
- An insurer-hired doctor without the proper training or specialization reviews your file and determines that you are not disabled, or talks to your treating doctor and determines that you are ready to return to work before that is actually possible
- You were surveilled by a private investigator who collected evidence video and photographic that your insurer alleges is inconsistent with your reported restrictions and limitations.
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Regular Or Own Occupation
The definition of “regular or own occupation” plan means you’ll receive benefits if you’re unable to perform the main duties of the job you had at the time the disability started.
You’ll still receive benefits even if you can work in a different job from the one you had before your disability, based on your training, experience and education. Some policies don’t allow you to get benefits, or may reduce your benefits, if you begin working in a different job.
In group policies, it’s common that policies have regular or own occupation plans for a specified period of time. At the end of the specified period of time, usually after the first 2 or 5 years, the disability policy will often change to the any occupation definition.
Own occupation plans that never change in definition are often purchased individually and usually cost more than any occupation plans.
You may want to consider an own occupation plan if you have a specialized occupation that would require you to take a significant pay cut in order to work in another field.
Other Sources Of Disability Benefits
You may also be eligible for benefits from the Canada Pension Plan and the Quebec Pension Plan to add to your income when you’re unable to work.
The CPP disability benefit and QPP disability benefit are available to people who have contributed to those plans and aren’t able to work regularly at any job because of a disability.
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Know Your Critical Dates
Some of your application paperwork must be submitted within a certain amount of time from the start of your leave from work often within the first 30 days. Late submissions may impact your eligibility for benefits. It may take time for your insurer to review, adjudicate and process your claim: it is common for the adjudication process to take at least 10 business days.
Short Term Disability Vs Long Term Disability
The main differences between short term and long term disability insurance are:
- The injuries and illnesses they cover.
- How long you can receive disability benefits.
- How long you have to wait following a disabling event to receive compensation.
|1, 7, 14, 30 days
|30, 60, 90, 180, 365 days
You shouldn’t skip long term disability insurance coverage in lieu of having just a short-term policy. Short term coverage will not be adequate in the event you suffer a serious injury or illness. Without long term coverage, you could find yourself without any kind of income after just a few months.
The best strategy is to buy an individual long term disability insurance policy then supplement it with any short term and/or long term group plans your employer may offer. By combining different types of coverage, you can protect your income against just about any type of injury or illness that would affect your ability to earn an income.
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When Is A Procedure Medically Necessary
The precise definition of a “medically necessary” procedure will be spelled out in your SDI plan documents. Often it will look require that the procedure is both:
- prescribed by a doctor as a required treatment of your injury or illness, and
- appropriate according to generally accepted standards of medical practice in the place where the surgery is performed.
If you’re wishing to apply for SDI benefits due to an operation and you’re wondering whether it will be covered by SDI, ask your surgeon whether he or she will certify that your procedure is necessary and appropriate for your condition. Then obtain a written statement from your doctor regarding the nature and extent of your condition and an explanation of why surgery is appropriate. Your doctor should also address your potential recovery period and any restrictions you will be under during that time. If your doctor won’t help you, find one who will. Your insurer will evaluate the opinion evidence from your doctor along with your recent medical records in deciding your case.
SDI plans usually require less evidence of disability than long term plans, because they only pay benefits for a very limited time. Still, your medical records and your doctor’s opinion must be sufficient to persuade your insurer of the medical necessity of your operation, or your claim may be denied.