Getting Short-Term Disability Benefits for Gastric Bypass

By , J.D.

If you are contemplating gastric bypass or other bariatric surgery as a treatment for obesity, you may be wondering how you'll pay your bills while you are undergoing and recovering from surgery. If your employer offers paid sick leave or vacation time, you may be able to use these benefits while you are unable to work. You may also be entitled to short-term disability benefits, which pay a percentage of your regular salary while you're unable to work due to an illness or injury that isn't related to work. (For on-the-job illnesses or injuries, workers' compensation provides benefits.) However, your eligibility for benefits will depend on the terms of your state's law or your insurance plan.

What Is Gastric Bypass Surgery?

Gastric bypass is a particular kind of bariatric surgery, a blanket term for a variety of weight loss surgeries that limit the size of your stomach (and therefore, how much food it can take in), limit your body's ability to absorb nutrients from food, or both. In a gastric bypass, the surgeon creates a small stomach pouch; food bypasses the rest of the stomach and part of the small intestine, which reduces the amount of nutrients and calories the body can absorb. There are different types of gastric bypass procedures, but all function to limit the size of the stomach and limit absorption of nutrients.

Gastric bypass is a treatment for morbid obesity, defined as a body mass index (BMI) of 40 or more. Body mass index is a ratio of height to weight; someone who is 5'10" would have a BMI of 40 if he weighed 280 pounds. Many physicians will perform gastric bypass or other bariatric surgeries only after the patient has tried and failed to lose weight through conventional methods.

What Does Short-Term Disability Insurance Cover?

There are a few ways you may be entitled to short-term disability coverage:

  • If you work in California, Hawaii, New Jersey, New York, or Rhode Island, state law requires employees to have temporary disability insurance coverage. In some states, benefits are paid from a state fund, with money coming from employee contributions, employer contributions, or both. Or, a state may require employers to purchase or provide this coverage for employees.
  • Your employer may voluntarily provide short-term disability coverage; your employer may pay the whole premium or you may have to make a contribution through payroll withholding.
  • You may have purchased your own short-term disability plan.

The terms of the plan (or state law, if the state provides benefits through its own fund) will determine which conditions are covered. Some plans cover gastric bypass surgery; others don't. For example, California's state law explicitly provides that elective procedures are covered. But many policies exclude elective procedures from coverage, which could preclude you from collecting benefits for taking time off for gastric bypass. If you are considering gastric bypass or other bariatric surgery, contact the state agency that administers the state insurance program, your human resources department, or your insurance carrier to learn the rules.

Contacting a Lawyer for Assistance

If you have been wrongly denied short-term disability benefits when you took time off for bariatric surgery, you may want to consult with an experienced attorney.

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