How Does Short-Term Disability Work?

Illnesses and injuries can happen when you least expect them. Whether you are recovering from surgery, experiencing complications from a medical condition, or temporarily unable to perform your job, missing work is a significant financial stress for most people. This is where short-term disability benefits can help.

Short-term disability insurance is designed to replace a portion of your income when you are unable to perform your job duties due to a qualifying illness or injury. However, many people are surprised that not all employers offer long-term disability insurance and short-term disability insurance. The rules in place also may depend on the policy.

If you are in Ohio and asking "how does short-term disability work?" here's what you should know about eligibility, benefits, and how the claims process generally unfolds.

What Is Short-Term Disability Insurance?

Short-term disability (STD) is a type of insurance that offers partial wage replacement when a medical condition temporarily prevents a person from working. Unlike workers' compensation, which covers injuries and illnesses that happened at work, short-term disability covers other conditions, no matter where or how they occurred.

Benefits are usually intended for temporary conditions that are expected to improve over time. Once you are able to go back to work, or the maximum benefit period has passed, the payments usually end.

Since short-term disability is usually offered through an employer or purchased as private insurance, the exact coverage depends on the terms of the plans.

Does Ohio Require Employers to Offer Short-Term Disability?

No. Employers are not required to offer their staff short-term disability. Many employers offer it as part of their employee benefits package, but others do not.

Since all of these policies are different, if your employer does offer it, it's important to look at plan documents. These will explain things like:

• Who is eligible

• When coverage begins

• How long benefits last

• How much income is replaced

• What medical conditions qualify

• How to file a claim

If your employer doesn't offer short-term disability, or you are self employed, you still might have options through an individual disability policy if you have purchased one.

What Conditions Qualify for Short-Term Disability?

All policies are different, but short-term disability benefits for employees generally cover temporary medical conditions that prevent you from performing the duties of your job. Examples of this include:

• Recovery after surgery

• Pregnancy and childbirth

• Serious illnesses

• Broken bones

• Severe back injuries

• Certain mental health conditions

• Complications from chronic illnesses

• Recovery from hospitalization

Simply having a diagnosis doesn't automatically qualify a person for benefits. Typically, you will need medical evidence that shows your condition prevents you from performing your job during the period of time you are out of work.

How Long Do Short-Term Disability Benefits Last?

Again, the length of benefits depend on the policy you have. Since they are all different, it's important to look at the plan's documentation. Most short-term disability benefits last for several weeks or a few months. Others last up to a year. After that, in most cases, long-term disability coverage may apply.

The exact duration depends on factors such as:

• The terms of your policy

• Your medical condition

• Your recovery progress

• Whether your physician determines you're able to return to work

Once you recover or reach the policy's maximum benefit period, payments generally stop, even if you haven't returned to work.

Is There a Waiting Period for Short-Term Disability Coverage?

Most short-term disability policies have an elimination period or waiting period. This is the time you must be unable to work before the benefits begin. Depending on the policy you have, the waiting period could be a few days or even a couple of weeks. During this time, most employees will use their sick time, paid time off (PTO), vacation time, personal leave, or other type of time off. Once the waiting period ends and the claim is approved, benefit payments typically begin based on the policy's terms and conditions.

How Much Does Short-Term Disability Pay?

It again depends on the policy. In most cases, the benefits only repay a percentage of your regular income instead of your full paycheck. Also, it looks at your weekly/biweekly wages and not your annual income. Since every individual policy is different, you need to look at the coverage. Most pay between 50% and 70%.

Another thing that you need to consider is if your disability benefits have a maximum benefit limit. In some cases, they do, and this means that higher-income employees generally receive less than the stated percentage once that maximum is reached.

It's very important to look at your policy documents and understand exactly how your benefits are calculated if you need to use the policy for short-term benefits.

How Do You Apply for Short-Term Disability?

This, too, depends on the policy. The process for applying depends on the policy itself and the insurance company. Most of them, however, follow a similar process. Generally, it goes like this:

• You need to notify your employer of your intention to apply

• They will give you a claim application, which you need to complete fully

• At some point you also need to provide medical documentation

• You will need to have your physician certify your disability

• Finally, you can submit any required employment information to the insurance company for review

The insurance company will review the documentation before deciding whether to approve or deny the claim.

Because incomplete paperwork is one of the most common reasons for delays, it's important to carefully complete every required form.

Why Are Some Claims Denied?

Receiving a denial can be frustrating, especially if your doctor has told you that you're unable to work.

Some common reasons claims are denied include:

• Insufficient medical evidence

• Missing documentation

• Failure to meet the policy's definition of disability

• Pre-existing condition exclusions

• Missed deadlines

• Failure to follow prescribed treatment

In some situations, the insurance company may request additional medical records or ask you to undergo an independent medical examination before making a final decision.

Can You Appeal a Denied Claim?

Yes, in many cases.

If your short-term disability claim is denied, you may have the right to appeal the decision. The appeal process typically allows you to submit additional medical evidence, clarify information contained in your application, or address the reasons given for the denial.

Appeals often have strict deadlines, so it's important to act promptly after receiving a denial letter.

An experienced disability attorney can review your claim, explain the reason for the denial, and help you determine the most effective strategy moving forward. They can also help explain what qualifies for short term disability.

How Is Short-Term Disability Different From Workers' Compensation?

People sometimes confuse short-term disability benefits with workers' compensation, but they're designed to address different situations.

Workers' compensation generally provides benefits for injuries and illnesses that occur because of your job or work environment.

Short-term disability, on the other hand, may provide benefits for qualifying medical conditions regardless of whether they occurred at work, depending on the terms of your policy.

For example, if you break your leg while skiing on vacation, you may qualify for short-term disability benefits if your policy covers the injury. However, workers' compensation would generally not apply because the injury did not arise out of your employment.

Conversely, if you injure your back lifting heavy equipment at work, workers' compensation may provide medical and wage-loss benefits, while short-term disability coverage may not apply or may coordinate with workers' compensation benefits depending on your policy.

Understanding which benefit program applies can help ensure you pursue the correct type of claim. For more information, a Columbus work injury law firm may be able to help.

What If Your Disability Lasts Longer Than Expected?

Some medical conditions take much longer to heal than originally anticipated.

If you're unable to return to work after your short-term disability benefits expire, you may need to explore other options, such as long-term disability benefits if they're available under your policy.

Depending on your condition, you may also qualify for Social Security Disability Insurance (SSDI). SSDI has its own eligibility requirements and application process, and approval often depends on proving that your condition is expected to last at least one year or result in death.

Transitioning from short-term disability to another type of benefit can be complicated, making it important to understand your rights and available options before your benefits end.

Understanding Your Options - Reach Out for Help

When you can't work due to a medical condition, the last thing you want to have to worry about is your income or your future. Understanding how short-term disability works, and what to do if your claim is denied or delayed, can make the process a lot easier to go through.

If you have questions about a disability claim, or if you need help appealing a denial, the attorneys at Larrimer & Larrimer have decades of experience working with workers in and around Columbus and across Ohio. The team can work with you and look at your situation, explain more about your rights, and help you pursue the benefits that you might be entitled to receive. Reach out today for a free consultation.