Short-Term Disability Benefits for Medical Operations

By , J.D.

If you have to miss work because of an illness or injury unrelated to your job, you may be entitled to short-term disability benefits. A handful of states provide employees with the right to short-term disability coverage; in states that don't, employers may also choose to offer this benefit voluntarily. If you have to undergo surgery or a medical procedure, your time off will often be covered by a short-term disability program.

Short-Term Disability Insurance Programs

There are a few ways you might be covered by a short-term disability insurance program.

  • If you work in California, Hawaii, New Hersey, New York, or Rhode Island, state law requires short-term disability benefits. Some states provide coverage through a state fund, typically paid for by employee contributions, employer contributions, or both. Or, the state may simply require that employers provide this insurance. If you work in one of these states, contact your human resources department or state labor department for more information on the program.
  • Your employer might offer short-term disability coverage voluntarily. Many employers offer this benefit for employees, either fully paid by the employer or subject to employee contributions. If you are covered by this type of policy, your human resources department can provide information on the plan.
  • You might have purchased your own short-term disability insurance. In this case, contact your insurance carrier for information on coverage.

Disabilities Covered By Short-Term Disability Insurance

What a particular policy covers and excludes will be determined by the plan's terms. Typically, a short-term disability plan provides some wage replacement (a percentage of your salary) while you are temporarily unable to work due to pregnancy or an illness or injury suffered off the job. Many plans don't cover elective surgery (such as cosmetic surgery or gastric bypass surgery). And some policies won't cover surgery for a pre-existing condition until you have been insured for a certain period of time.

The key is that your surgery must be medically necessary. Common examples of medical operations that might qualify you for short-term disability benefits include:

  • open heart surgery
  • caesarean section birth
  • removal of gallbladder or other internal organs
  • surgery related to broken bones, and
  • knee or hip replacement surgery.

Obtaining Short-Term Disability Benefits for Medical Operations

Contact your human resources department or your insurance carrier as soon as you know you will need surgery. Generally, you will need to complete and submit a claim form; your doctor and your employer will each have to complete part of the form. Many policies impose a waiting period of up to seven days, so you probably won't receive benefits for the full period of your time off. How much money you get, how long benefits last, and other details will all be determined by the terms of the policy. Most plans provide coverage for three to six months, at about 60% of your previous salary.

Hiring a Disability Attorney

If you believe you were wrongly denied coverage for a medical procedure under a short-term disability plan, you may want to consult with a disability lawyer. A lawyer can review the plan and help you figure out your entitlement to coverage; if you decide to appeal the denial, the lawyer can assist with that as well.

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