Confusion abounds around what short term disability insurance does and does not cover. Using an outline of coverage from a leading provider of employee paid short term disability ; this article will provide a brief answer to the most commonly asked coverage questions.
Each policy is different, and each insurance company uses different rules and language; so your policy may be different. Read your policy language for a definite answer. Answers to the most common questions are broken down as follows:
- Covered medical conditions
- Dependents and other family members
- Pre-existing conditions and other limitations
Cancer Surgery and Treatment
Short term disability covers cancer, and a cancer diagnosis is one of the most common causes for claims of any length. But that is not a guarantee that your policy will protect you just because you have cancer. The key questions are:
- Does your cancer prevent you from working? Many people with cancer can continue working while receiving treatments.
- Were you totally disabled first? Cancer patients undergoing chemotherapy and/or radiation may be able to work partial hours while receiving treatment. Partial disability payments are covered, but only if you were totally disabled first, and receive total disability benefits for thirty days or more.
Cancer surgery is perhaps the most common trigger for a total disability claim. During your postoperative recovery you may not be able to work at all – meaning a total disability claim. Follow up chemotherapy and radiation treatments may prolong your full recovery, and make you too weak to work.
Sometimes a spouse of family member may need to stop working to provide for a family member battling cancer. As you will see below, dependents and family leave is not covered, one of the primary reasons why cancer insurance is worthwhile .
Short term disability does not cover most dependents unless a policy was purchased to insure this person. Your spouse’s disability is generally not covered by your individual policy. Some employee paid accident plans allow you to purchase a disability rider than can protect both spouses. You would have to have this type of policy in force.
Most children are not working or earning an income, so benefits are not paid when children are sick or injured, and require care at home. Two states (California and New Jersey) have paid family leave programs that cover care for children by a parent.
Adoption is not covered. When couple adopts a newborn, one or both parents may stop working to care for the infant at home. While family leave laws such as the FMLA will provide job protected leave, most private policies are designed to make payments when the employee is physically unable to work.
disability does not protect you from losses caused by any mental or emotional disease. Employees taking stress leave, or dealing with mood disorders such as depression do not qualify.
Alcohol and drug rehabilitation treatment are not covered; except addiction to drugs taken as prescribed by a medical doctor.
Parental and Medical Leave
Short term disability and the Family Medical Leave Act (FMLA) address two entirely different exposures. One does not fall under the other. One is a private insurance policy providing income replacement, the other is a federal law mandating job protection.
Short term disability insurance covers the person who is unable to work due to a medical condition, and replaces a portion of income during this time. Paternity leave is not protected, because dad does not have a medical condition preventing him from working. Maternity leave is insured because mom is recovering from childbirth.
FMLA is a federal law protecting your job while on leave to care for a sick family member, or during your own disability. FMLA provides for unpaid leave. Both maternity and paternity leave are covered under FMLA.
Vacations are not covered. People actually ask this question, which seems quite funny to me.
Short term disability insurance does not cover pre-existing conditions during the first twelve months after the policy effective date. However, if you become disabled after the policy has been in force for twelve months, then your pre-existing condition may be covered.
Apply for a short-term loan if you need funding and do not have coverage already in force.
Gastric bypass surgery is a common pre-existing health condition that may be insured. Gastric bypass is used by people struggling with obesity, a condition that does not crop up overnight. People considering a gastric bypass can purchase a policy a year in advance of the surgery, and may find the claims payment exceeds premium cost.
Other elective may surgeries work in a similar fashion: knee and hip replacements, ACL repair, cosmetic procedures (plastic surgery), hysterectomy, tubal ligation, tubal ligation reversal, and others
Short term disability covers pregnancy related conditions. In fact, pregnancy related conditions are the most common claims reasons for employee paid policies – as policies purchased at work insure normal pregnancy.
Employee paid policies address mom’s maternity leave when she stops working to recover from her normal childbirth. Bed rest preceding delivery is covered when a specific pregnancy related medical condition drives the prescription. Bed rest by itself is not a qualifying diagnosis. Postpartum complications are also very common may qualify if they delay your return to work. If this is your need be sure to ask your employer to offer a voluntary option .
Postpartum depression is considered a mental health issue.
What questions do you have about what might be protected?