Navigating a Leave of Absence: Understanding Short-Term Disability and Long-Term Disability
Taking a leave of absence from work due to a medical condition can be overwhelming. Beyond managing your health, you face the overwhelming challenge of securing your financial future when navigating the unknown of logistics and paperwork associated with filing for long- or short-term disability. Short-Term Disability (STD) and Long-Term Disability (LTD) insurance can be incredibly beneficial, but it’s important to first understand the differences, qualifications, and application process for each to ensure that you have a smooth transition during a difficult time.
Short-term and long-term disability policies vary on a state-by-state basis. It is always best practice to align with your employer/HR team as well as your medical care team to see what policies are available to you and align with your needs. A general overview of the policies are:
Short-Term Disability:
Short-Term Disability (STD): This benefit is for temporary disabilities. It typically kicks in after a short waiting (elimination) period (often 1-14 days) and provides benefits for a short duration, usually 1 to 12 months.
Most states do not mandate STD insurance, but a few do, often referred to as Temporary Disability Insurance (TDI) or Paid Family and Medical Leave (PFML/FMLA/FAMLI) programs.
Currently, there are 5 states with state-sponsored disability plans that are funded by mandatory contributions made by employees. The states that have these programs are California, Hawaii, New Jersey, New York, and Rhode Island. However, many states are in the process of creating programs. Each state has different eligibility guidelines and details regarding how their programs are administered, including how long you have worked for your employer, how long you must have been disabled before you can apply for benefits, and what percentage of your salary is payable by the benefit plan. It is always best practice to connect with your state via phone or email to understand what benefits are available to you.
Long-Term Disability:
Long-Term Disability (LTD): This is for severe, extended, or permanent disabilities. LTD benefits usually begin after the STD period ends (often an elimination period of 90 to 180 days) and can last for several years, even up to retirement age, depending on the policy.
For Long-Term Disability (LTD), the primary program is federal: Social Security Disability Insurance (SSDI), and Supplemental Security Income (SSI). Most states do not have their own standalone long-term disability cash benefit programs. Long-term disability insurance is usually private, through an employer or purchased individually.
LTD policies often require you to apply for Social Security Disability Insurance (SSDI) once your disability appears to be long-term. The application for SSDI is made directly to the Social Security Administration (SSA). The LTD company will then often offset your monthly benefit by the amount you receive from Social Security.
Starting the Application Process
The application process for disability benefits largely depends on where your coverage comes from: your employer, a private policy, or a state-run program.
Application Steps for Employer-Provided (or Private) Insurance
Most STD and LTD policies are employer-sponsored, meaning you apply through your company's Human Resources (HR) department or directly to the insurance administrator (e.g., MetLife, Unum, Guardian, etc.).
Notify Your Employer/HR: This is the critical first step. Inform your HR department or manager about your need for a leave of absence and your intention to file a disability claim. They will provide you with the necessary application forms and policy documents.
Gather Policy Information: Review your policy documents to understand:
The definition of "disability" (Does it mean you can't do your job or any job?).
The elimination (waiting) period before benefits begin.
The maximum benefit period.
The filing deadline.
Complete the Forms (Employee Statement): You will need to fill out your section of the claim form, which typically includes your contact information, employment details, and a narrative about your medical condition.
Obtain a Medical Statement (Attending Physician's Statement): This is the most vital part. Your doctor must complete a detailed form that outlines your diagnosis, treatment plan, symptoms, objective findings, and, most importantly, how your condition prevents you from performing your job duties and an estimated return-to-work date.
Submit the Full Application: Ensure all sections (Employee, Employer/HR, and Physician) are completed accurately and submitted by the policy deadline.
Applying to a State Program
Again, a few states offer mandatory disability insurance programs (ex: California, New York, New Jersey, Rhode Island, and Hawaii). If you live in one of these, you'll apply directly to the state's department of labor or equivalent agency. It is important to connect with your state to see what benefits are available to you and your specific condition.
Typical Disabilities That May Qualify
Generally, both STD and LTD cover any non-work-related illness or injury that is medically verifiable and prevents you from performing your job for the required duration. It is essential to talk with your medical provider or medical care team to understand more about your disability and the qualifying condition as it may vary on a case by case basis. This is not an exhaustive list, but are common qualifying conditions for STD and LTD:
Short-Term Disability:
Pregnancy and childbirth
Recovery from surgery (ex: hip replacement, ACL repair, appendectomy, etc.)
Acute injuries (ex: broken bones, torn ligaments, severe sprains, etc.)
Severe mental health episodes (ex: temporary/severe anxiety or depression)
Long-Term Disability:
Musculoskeletal disorders (ex: severe back pain, chronic arthritis)
Severe cardiovascular conditions (ex: post heart attack complications)
Chronic and severe mental health or neurological conditions (ex: multiple sclerosis, severe bipolar disorder)
*Note: Medical professionals will define and determine the severity of the condition
Common Questions and Answers for Taking STD/LTD
1. How long will I get paid?
STD: Typically 1-12 months, as defined by your company or insurance policy.
LTD: Can last until the policy's maximum benefit period (ex: 5 years, 10 years) or until you reach retirement age, as long as you remain medically disabled per the policy's terms.
2. How much of my income will I receive?
STD: Often pays a higher percentage, typically 60% to 100% of your pre-disability income.
LTD: Usually pays less, often 50% to 70% of your pre-disability income.
3. Will my claim be automatically approved for LTD if I was on STD?
No. While the transition is common, your LTD claim is a separate application and review. LTD policies have a stricter definition of disability and require updated, extensive medical evidence to prove your condition continues to prevent you from working.
4. What is the "elimination period"?
This is the waiting period between the date you become disabled and the date your benefits begin to be paid. For STD, it's usually short (ex: 7-14 days). For LTD, it's longer (ex: 90 days), often designed to be covered by your STD benefits, sick leave, or personal savings.
Conclusion
Though taking a STD or LTD can be a challenge, in many cases, it is essential for the individual’s health and well-being. Again, it is always best practice to consult with your state, insurance company, medical provider, and HR team to determine what is the right fit for you. The intent of this blog post is to provide you with general information on how to begin your process, but it does not constitute legal or insurance advice. Always consult your specific policy documents with your HR department, lawyer, or qualified professional to receive individualized guidance on your specific situation.
For more information on what to do when you return from a leave of absence, check out our blog: Preparing for Your Return From Medical Leave: Your Guide to a Smooth Transition .
