Short-term disability insurance provides cash benefits for workers who are temporarily unable to work due to illness, injury, or pregnancy. Short-term disability (STD) insurance typically pays about 60% of your regular wages for a period ranging from three to six months.
Generally, you can get short-term disability in one of three ways:
Only a few states have laws providing short-term disability benefits. California, New Jersey, and Rhode Island require most employers to participate in state-run TDI programs (funded through payroll deduction and taxes on employers). In New York and Hawaii, employers must either purchase SDI for their employees or self-insure.
In states that don't mandate SDI or TDI benefits, many employers choose to provide private disability insurance coverage as a benefit of employment. Some companies pay the premiums entirely themselves, while others require some employee contributions.
If you don't have short-term disability insurance provided by your employer or your state, you can purchase coverage from insurance companies on your own.
Individual SDI or TDI programs vary somewhat, but all are designed to replace some of your wages should an off-work incident or illness cause you to become temporarily disabled. (Work-related disabilities fall under workers' compensation programs.) Here's an overview of how short-term disability works, the required waiting periods, and what to do if your SDI or TDI claim is denied.
Almost all short-term disability policies have a waiting period (known as an "elimination period") between the event that caused your disability and when your benefits begin. The waiting period for state-run SDI/TDI programs is usually 7 days. For employer-purchased or private coverage, the waiting period will usually be one or two weeks but can be as long as 30 days or more—especially for "pre-existing conditions."
For instance, pregnancy is generally covered under SDI policies, but it's often considered a pre-existing condition. So, you might have to carry STD insurance for nine months before you can collect any benefits for pregnancy. (Disability insurance policies, unlike health insurance policies, are allowed to impose waiting periods on pre-existing conditions.)
If you have both short-term and long-term disability coverage, your short-term benefits usually last until the waiting period of the long-term disability policy is over. That can be as little as a couple of months or as long as a year, but the average is six months.
The first step to getting short-term disability benefits is to obtain a copy of the claim form from your employer's human resources department or your own insurance carrier (if you purchased coverage for yourself). This form will usually ask for the following information:
Next, you'll have to request that your employer and physician complete their portions of the claim form. Your employer will provide information about your job description, salary, and history with the company, while your doctor will generally be required to certify that your medical condition prevents you from working.
After you submit the claim form to the insurance carrier or state agency that administers the program, the insurance program's claims administrator will request your medical records and review them to make sure they're consistent with the disability you're claiming.
How long it takes your SDI or TDI program to process a short-term disability claim will vary, depending on the program's policies. Some claims can be approved (or denied) in as little as five days, especially claims with a state-run program.
Generally, most insurance companies must decide your claim within 30-45 days. But approval can take longer if an insurance company has to wait for copies of your medical records or other information needed to make a determination.
Here are some things you can do to ensure the STD insurance claims process goes as quickly and smoothly as possible.
Fill out the claim form completely. If you leave anything blank, it could delay the claims process. If your claim form has a section for your employer to complete (as most state-run SDI/TDI programs and employer-sponsored STD policies do), get it filled out right away.
Be sure the information you provide is correct and complete. Dot every "I" and cross every "T." When explaining the nature of your injury or illness, include a detailed explanation of the limitations your condition is causing and how they make you unable to do your job.
For example, don't just say you broke your leg. Explain that you can't stand for more than a few minutes or walk without crutches and that your doctor has restricted you to lifting no more than ten pounds.
Provide medical evidence that backs up your claim. Whether it's part of your claim form or a separate form, you'll need a statement from your doctor that describes your disability, including:
The insurance company might also need to see medical records that back up your disability claim. Your insurance company might want to see any of the following:
Get your claim form in quickly. The insurance company can't start processing your claim until you submit the paperwork. The longer you take to file your claim, the longer it'll take for you to start receiving benefits. Be sure to follow the submission instructions.
If you have questions, ask your insurance provider. If you're unsure about the claims procedure, where to send your claim form, or anything else regarding the claims process, call the administrator and ask. You can also ask how long it will take to process your claim and when you can expect to begin getting benefits once it's approved.
If you've just started your job and need to file a short-term disability insurance claim, check the terms of your policy to see whether your coverage has started yet. Many plans require that you've worked a certain amount of time (six months is common) before coverage begins. And most employers require that you exhaust your paid sick leave before you can draw any STD benefits.
If your illness or injury isn't work-related and it prevents you from working—that is, you can't perform the material duties of your job—you'll likely be eligible for STD benefits. For instance, let's say you broke your leg skiing. If your job requires you to be on your feet for long periods of time (like a restaurant worker or delivery person), your injury would likely qualify you for short-term disability because you couldn't perform the basic duties of your job.
Most surgeries, other than those for purely cosmetic reasons, are covered by short-term disability insurance as long as your doctor certifies that the procedure is "medically necessary." (Organ donation is the lone exception to the "medically necessary" provision. It's generally covered.) Bariatric (weight-loss) surgery is often covered by STD insurance, but not always, so check the terms of your plan.
Many prescription medications can cause side effects that also give rise to a successful STD claim.
Pregnant women are generally eligible for short-term disability benefits for a few weeks to several months, covering the end stages of pregnancy and a period of recovery after delivery. But for employer-purchased or private STD policies, coverage typically can't begin until nine months after your policy goes into effect (because of the pre-existing condition rule).
If your initial claim for STD benefits is denied, you should seriously consider filing an appeal, either on your own or with the help of an attorney. The instructions and deadlines for appealing your denial are usually contained in your denial letter, along with an explanation of why your claim was denied.
When filing your appeal, you'll need to collect as much medical evidence as possible to strengthen your case. Supplementing your claim file with additional doctors' opinions and medical records can greatly increase your chances of winning your appeal. Even written statements from friends, family members, and (perhaps most importantly) co-workers who have observed your struggles can be beneficial.
If you feel like you're facing an uphill battle, an experienced disability attorney will not only handle the paperwork and deadlines associated with your appeal, but an attorney will also understand what sorts of evidence will persuade the insurance company that you're unable to work.
If your short-term disability payments expire (because you've received them for the maximum period of time), and you're still unable to work, you might be able to apply for:
A disability attorney can assist you in filing for longer-term benefits if and when the time comes that you need them.
Updated October 18, 2022