Short-term disability benefits replace lost income when you're unable to work on a temporary basis, usually for a short period of time due to an illness, injury or maternity. While some states have enacted laws or regulations requiring private employers to offer short-term disability insurance to their workers, Virginia has not. However, Virginia law does regulate the terms of such policies where they exist. So it's important to know what's legally required before you file a claim and also in the event that your claim is denied.
Understand the Waiting Period Rules
As a general rule, employees must sign up for short-term disability insurance coverage prior to the event that renders them temporarily disabled and unable to work. Additionally, Virginia law requires that benefits under these policies begin seven calendar days after the employee's condition first manifests, whether that's a disability or it is related to maternity leave. However, if you have suffered a catastrophic injury or if you have a chronic condition that's considered life-threatening and is not expected to improve with treatment or time, then the seven-day waiting period may be waived.
Know the Benefits Schedule
Short-term benefits are payable for a maximum of 125 days. If your claim is approved, you'll receive a percentage of your income, based upon the number of months you have been employed. Benefits are payable in 60 percent, 80 percent and 100 percent increments. For example, if you've been on the job for over 180 months, you will qualify for these benefits:
- For the first 25 days, the policy will pay out 100 percent of your salary.
- Over the next 75 days, you'll be compensated at 80 percent.
- The final 25 days are payable at 60 percent.
Private policies – those purchased outside the scope of your employment relationship – may cover only complications of pregnancy, instead of a normal uncomplicated pregnancy, labor, delivery and recovery.
When Claims May Be Denied
Short-term disability benefits are not available to individuals who have elective procedures during their first six months of employment. Your claim may also be denied if you do not file your claim properly or fail to submit the required supporting documentation of your temporary disability.
Successive Periods of Disability
Sometimes, an employee may suffer a relapse, a re-injury or other continuation of a debilitating condition. When these periods of renewed temporary disability happen within 45 consecutive calendar days of your return to work from the prior disability period, Virginia law calls it a successive period of disability. This means that it's considered to be a continuation of your prior disability, not a new disability. If you're able to work for more than 45 consecutive calendar days, then any subsequent disability is considered a new occurrence.
Also, the 45-day rule applies only to employees who have been medically released to return to full-time employment without any restrictions on their activities.
Read More: Rules of Short Term Disability
How to File a Claim
To file a claim for short-term disability benefits under a policy on which you're the insured party, you'll first need to obtain a claim form. These can usually be downloaded from your insurer's website or your employer's human resources department if the policy was purchased through your employer.
Be sure to fill out the claim form completely and accurately. Any errors or gaps in the information you provide may result in a delay or denial of coverage.
What to Do if You're Not Covered
If you're a Virginia worker without access to short-term disability insurance benefits, there are a few avenues of public assistance to explore. Contact your local Department of Social Services office to see if you qualify for programs that offer financial assistance for food, child care, medical care or assistance in the wake of a natural disaster.
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