Understanding Short Term Disability Benefits Eligibility
If you suffer a disabling injury or illness that requires treatment and appropriate medical care for a short period of time (typically 12 months or less), short-term disability (STD) insurance benefits can provide you with income replacement. Your STD income replacement benefits are based on your monthly income, along with a predetermined percentage of this income that your plan will pay out each month in the event of a covered, short-term disability after a waiting period.
As with long-term disability (LTD) insurance, not every STD policy covers every injury or illness—however disabling it is. Examples of commonly excluded short-term disabling conditions are, mental illness and usually workers’ compensation related claims.
Your disability insurance policy should detail which conditions are included and categorically excluded. Most STD plans cover:
- Neck, back, knee, and hand issues
- Heart attack
- Gastrointestinal problems
- Lyme Disease
Your policy will inform you about specific short-term disability benefit start and end dates, the percentage of your monthly income, and the requirements for benefits.
To receive short-term disability benefits through any insurance company, the policyholder must first file a timely claim and meet all ”proof of loss” requirements.
Significant Terms to Remember
Despite variations in language between insurance company policies, major insurance companies tend to use similar concepts, terms and definitions relevant to STD benefits, including:
- Initial enrollment period: A new employee is often eligible to sign up for group employer-provided disability insurance coverage during an open enrollment period. You will receive this information upon hire. If you have questions, contact your human resources department for more information. This period is often a window from the start of your employment until a certain date past which your eligibility for enrollment ceases, absent certain life changes. Thirty-to-sixty day enrollment periods are common. Because initial or open enrollment is optional in many cases, the failure to enroll will mean that this optional plan will not cover you in the event of a short-term disability.
- Minimum service period: For disability insurance that an employer provides, the employer may require that employees are employed for a specified amount of time before they receive coverage.
- Elimination period: This term refers to the amount of time between the onset of a claimant’s disability and the point at which the claimant becomes eligible to receive monthly disability benefits. Often, eligibility is not at the same point as the disability’s onset. Instead, the claimant must wait a specific amount of time before eligibility kicks in. For this reason, the elimination period is also known as the “waiting period.” Insurers normally communicate this, and more, in the policy booklets or certificate you receive.
- Pay cap: This term refers to the total amount of monthly disability benefits to which a particular insurance policy entitles a claimant. In the event a claimant has purchased multiple insurance policies, insurers often offset the amount of money they pay out each month by the amount that the claimant receives from other sources to ensure that an over-insurance situation doesn’t occur.
More About Short-Term Disability
Insurance companies limit who has access to disability benefits through exclusions for pre-existing conditions. Private short-term disability insurance generally does not cover pre-existing conditions. An individual can’t receive a diagnosis, schedule a medical procedure, and then purchase short-term disability insurance expecting to be covered.
You May Have More Options After Wrongful 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” that your insurer alleges negates the disability you’ve claimed
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:
- Denial or delay letters.
- Notes and dates from as many phone and email conversations you had with your insurer—or any other relevant professional—relating 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 can’t locate, and save everything moving forward.
If Your Disability Claim Was Wrongfully Delayed or Denied, Please Contact Us Today!
The top-rated, seasoned attorneys at the nationwide disability insurance law firm DarrasLaw have recovered millions on behalf of disabled individuals who were wrongfully denied the benefits to which they were entitled.
Common red flags we have seen that indicate bad-faith delays or wrongful denials of disability coverage include:
- Requests for independent medical examinations with doctors in the wrong specialty or with inadequate training
- Massive requests for the duplicative documentation
- Denials that are unaccompanied by any real explanation or logical proof
- Failing to make a claim decision within a reasonable amount of time
- Failing to relate relevant information to the claimant
DarrasLaw can help you can fight back! We’ve taken on every major disability insurance company and won. Reach out to the top-rated disability insurance lawyers and ERISA attorneys at DarrasLaw at (800) 458-4577 or contact us online for a free policy analysis or claim consultation.