Short-term disability insurance coverage kicks in after you've missed a required amount of time at work, depending on the specifics of your policy. The qualifying process likewise depends on your policy, but several general trends can give you a good idea of what to expect when you apply for benefits.
Specific conditions covered by short-term disability policies depend on the insurer and the plan selected. However, according to a claims analysis conducted by the disability insurance provider Unum, the top reasons cited for short-term disability leave claims are:
- Pregnancy: 28 percent
- Injury: 11 percent
- Joint disorders: 7 percent
- Digestive Issues: 7 percent
- Cancer: 7 percent
In addition, a Cigna study looking back at 20 years of short-term disability claims found that from 1993-2012, absences related to treatments for obesity, skin cancer and herniated discs increased significantly. In some cases, a contributing factor is the increased availability of treatment options. For example, short-term disability treatments for obesity rose 3,300 percent over the 20-year period, which Cigna attributes in part to the increased availability of bariatric surgery. Similarly, Cigna noted a 45 percent increase in work absences related to herniated discs -- but the average work time missed decreased as new techniques in back surgery got sufferers back to the office sooner.
Filing Your Claim
Your workplace likely has a claims process for filing short-term disability claims already in place. If your short-term disability coverage comes through your employer, expect it to be very involved in handling your claim. If the illness or injury isn't work-related, notify your supervisor or human resources representative that you can't work and will need to file a claim. Your employer will send you the required paperwork, which will ask you to detail when the condition first appeared, when you first missed work and information on any previous disability claims filed over the past year.
You'll have to authorize your employer to contact your attending physician. This allows the policy issuer to investigate your claim and determine whether you qualify for benefits. Your physician will have to certify that you've suffered the ailment or injury, and that it prevents you from performing your job. Your employer or the policy underwriter can deny the claim if they are not satisfied that your condition is severe enough to qualify. This can be a risk for those seeking treatment for depression or anxiety, for example, which may not have as obvious effect as cancer treatment or a shattered fibula.
If your short-term disability is the result of a work-related injury or illness caused by your job, you'll likely turn to worker's compensation instead of short-term disability coverage.
As a general rule, you'll have to use your allotment of accrued sick days before short-term disability kicks in. Sometimes you'll have to burn vacation days as well. This part of the elimination period -- the time between your initial absence and when you qualify to start accepting short-term disability -- varies based on your policy guidelines. If you have to miss work more than once for the same condition -- for example, multiple rounds of cancer treatment -- you won't have to wait through an elimination period again, but will be eligible to collect short-term benefits immediately.
Once your claim has been approved, you're covered as long as you're out of work up to the maximum your policy allows. Sometimes benefits will be allocated through a specific date based on the assessment of you and your physician about when you'll be able to work again. If you're out for longer, you'll need to apply for an extension of benefits.
You can't receive benefits until your elimination period has passed, but you don't have to wait until then to file a claim. Aetna recommends that you file as soon as you or your doctor determine that your disability is likely to last at least as long as the elimination period. That way, you'll be ready to collect from the policy as soon as you're eligible.
Not Everything Covered
Short-term benefits don't cover every affliction that keeps you out of the office. Some conditions that could result in a denied claim include:
- Disability caused by a self-inflicted injury, an act of war, or an attempt to commit a felony
- Sickness or injury covered by worker's compensation
- Injuries that occurred while you were intoxicated, or under the influence of illegal drugs
Some policies also exclude specific conditions. For example, Mutual of Omaha's standard short-term disability policies exclude "mental or nervous disorders." Others require you to remain under a physician's continuing care for your condition to retain your benefits.