Short-term disability coverage may be offered through your state or employer, and you also have the option of purchasing a plan yourself. Any medically-necessary reason to stay home from work may seem like a good reason to extend a disability claim but your policy guidelines dictate whether or not you'll get the extension.
Qualifying for Short-Term Disability
To qualify for short-term disability, patients generally must be under the care of a physician who provides satisfactory evidence of the disability. This evidence -- like a note, report or a copy of medical documents -- must state that you have a medical condition that makes you unable to work. When the insurance company approves your claim, it will specify how long the coverage lasts based on the information provided by your physician.
Reasons to Get an Extension
Things don't always go as planned when you're on short-term disability. If your doctor feels it's medically necessary for you to refrain from working, you may be able to get your claim extended. This can happen because:
- You're not recovering as quickly as your doctor estimated.
- You were reinjured.
- There was a complication in your surgery or you developed an infection.
DisabilitySecrets also notes that women who recently have given birth often can continue to receive benefits if they experience a postpartum disorder or ongoing health issues related to the delivery.
Getting the Extension
If you know you're not going to be able to return to work by the end date of your original claim, start the extension process right away. Contact your employer if the insurance is provided through work. Otherwise, contact the insurance company directly.
Your employer or insurance company will most likely require new evidence from your physician that supports the extension. To get this information, the insurance company will contact your doctor and request that he complete and return an extension form that details your medical complications. The insurance company will review the completed document and, if you're eligible for more benefits, will alert you that your claim is approved.
Limitations on Extensions
If your doctor provides evidence that it is medically necessary that you wait to return to work, the reason for your extension probably is valid. However, having a valid reason for an extension doesn't mean that your insurance will grant it.
Insurance policies may specifically note what conditions qualify for an extension and what don't qualify. If the plan policy specifically excludes a condition -- like stress or depression, for example -- it may reject your request.
In addition, insurance policies often have hard caps regarding how much short-term disability benefit they offer. For example, the short-term disability coverage offered by the Public Employee's Benefit Board of Oregon has a maximum benefit period of 13 weeks. The plan literature notes that, even if an employee continues to be disabled, the coverage cannot last longer than that.
Read through your plan policy and note the maximum annual benefit period and any coverage restrictions. PatientAdvocate.org notes that a maximum benefit of 90 to 180 days is common.
What to Do if You Can't Get an Extension
If your insurance company rejected your request for an extension, all hope isn't lost.