How to Get Short-Term Disability in Pennsylvania

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Short-term disability is a type of insurance coverage that replaces a portion of an individual's income when they are unable to perform their job due to a covered medical issue. While Social Security disability benefits kick in for conditions expected to last 12 months or more, short-term disabilities are those that do not meet this time frame.

Pennsylvania does not require employers in the state to offer short-term disability benefits, and it is not considered a universal right. Short-term disability benefits are available for eligible individuals who work for the state and opt into the program, paying for premiums themselves.

However, other employees are only able to get these benefits if their employer offers them or if they purchase private coverage before the issue arises.

Disability Insurance in Pennsylvania

Disability insurance, under both federal and state laws, relates primarily to employment in the United States. That is because the principal economic loss resulting from a physical or mental disability is loss of income. Both long-term and short-term disability is almost always described in terms of the amount of time that an individual is unable to work.

The nationwide disability insurance coverage accessible to Americans is offered through the Social Security Administration. Most workers are eligible for this coverage if they work a sufficient period of time to qualify and suffer a disability that is expected to keep them off the job for at least a year.

Some employers also offer disability coverage and, finally, it is possible to purchase private disability insurance.

Disability Insurance Covers Lost Income Only

Many people have a misconception of disability coverage, confusing it with medical care coverage in their minds. In fact, these are two entirely different matters. An individual who becomes disabled might need medical care, but that treatment is not covered by disability insurance. Rather, they must look to their regular medical coverage to pay for this.

For example, if someone is in a car accident and ends up with a broken spine, they clearly require a trip to the emergency room and will likely need more than one follow-up visit.

If a person falls off a ladder while changing a light bulb and hits their head, they may need to go to the doctor. But these cases are not included in disability coverage. Any available disability insurance only comes into play if the person was employed and unable to work because of the disability they suffered.

Personal Injury Claims

It is easy to confuse disability coverage with the type of damages one might claim in a personal injury case. Take the example given above of the automobile accident case.

If the other driver were at fault, the injured person could claim not just lost income as their damages, but also all medical bills, including ambulance costs. They could also seek damages for pain and suffering.

Private Disability Insurance

Disability insurance does not cover medical bills or pain and suffering, and purchasing private disability insurance can be quite expensive. The cost varies from expensive to extremely expensive depending in large part on certain factors:

  • How strict the requirements are for qualifying under the disability plans.
  • Individual's salary.
  • Amount of time the insured can get benefits.
  • Person's medical history.
  • Waiting period required before an insured can begin to collect benefits.

Why does the amount of the person's salary come into play? Because the disability insurance will be replacing that salary, in whole or in part, if the person can no longer do their job. Imagine that the person in the automobile accident was an employee who was unable to work for 10 months after the accident.

If they earned $250,000 per year, disability insurance would compensate them for some of their lost income. The payments would be greater than for someone earning $25,000 a year.

Qualifying for Disability Coverage

Even an employee lucky enough to have short-term disability coverage in Pennsylvania might find it challenging to qualify for insurance assistance. It is important to read a policy carefully in order to determine the applicable definition of disability and what an insured must prove to qualify for benefits.

Sometimes the requirements are hard to establish. This is true even for federal Social Security Disability Insurance (SSDI). Those who have put in the years of work to qualify still have to prove a number of conditions, including that they will be out of work for at least a year or that the disability will kill them. They must also prove that because of the disability, they cannot engage in any type of meaningful work.

An employee covered by a private plan might have less stringent qualification requirements. In some cases, the insured only needs to show that they can no longer continue in the same line of work in which they were previously engaged. For these plans, with easier qualifying conditions, premiums will likely be higher.

Social Security Disability Insurance

Social Security Disability Insurance (SSDI) is a federal program that applies nationally to workers in all states. It is, without question, the disability option that covers the most workers in the U.S. and in Pennsylvania.

It provides partial coverage of lost income for eligible employees who are unable to work because of a disability, but it only applies to those with long-term disability.

Note that, although SSDI is the primary disability coverage across the nation, coverage is not open to all. This program is an "earned" benefit, and available only to those who have paid into it and earned enough work history credits to be eligible.

Funding of SSDI and Eligibility Requirements

It is funded through a federal tax on employment income, with a percentage of income deducted from employees’ paychecks in all jobs covered by Social Security. Self-employed individuals pay the percentage contributions themselves based on their net earnings.

And, as described above, the disabling medical condition that qualifies an individual for SSDI benefits is only met if a medical doctor declares in writing that they project it to last at least one entire year or the disability is expected to result in death. This clearly means that any employee with a partial disability or a short-term disability cannot expect to qualify for SSDI.

Pennsylvania State Disability Insurance Benefits

The Commonwealth of Pennsylvania offers short-term disability options to its employees. These insurance benefits are not, however, funded by the taxpayers of the state. Rather, Pennsylvania allows state government employees to buy short-term disability insurance.

That is, employees have the option of enrolling in the program and paying the premiums themselves through payroll deductions. However, certain restrictions apply.

Anyone who started working for the state before July 1, 2010, is not eligible for disability benefits until they work at least three years. Anyone hiring after that date must work for five years before claiming short-term benefits.

There is an exception to this waiting period. Those in the State Patrol and Correctional Employees Retirement Plan are immediately eligible for disability benefits for on-the-job injuries.

Pennsylvania Workers Compensation Benefits

Under Pennsylvania law, employers are obligated to purchase Workers' Compensation Insurance coverage on behalf of their employees. This mandatory coverage is overseen by the State Workers Insurance Fund. Note that these benefits are usually available only if a worker is injured on the job or in job-related activities.

Like Workers' Compensation coverage in all states, the program in Pennsylvania provides a variety of benefits in addition to temporary income loss. These include temporary disability benefits for occupational accidents and illnesses, as well as other medical care and supplies necessary to take care of the temporary disability. These include:

  • Regional services and medical care.
  • Services rendered by physicians or other health care providers.
  • Hospital treatment and supplies.
  • Prescription medicines and supplies.
  • Orthopedic appliances and supplies.

If a worker is disabled as a result of an on-the-job injury, they may be able to obtain medical care and some portion of their lost income by filing for Workers' Compensation benefits. This may provide a lower percentage of income replacement than a private short-term disability policy, however.

Pennsylvania Unemployment Benefits

Don't look to the Pennsylvania Unemployment Benefit program to assist with temporary disability benefits. In fact, any worker eligible for one will be ineligible for the other. This might seem odd since getting injured or disabled may be one of the most common reasons that people cannot work. Yet the aims of the two programs are at odds.

Qualifying for Short-term Benefits

Short-term disability benefits are intended to assist those who cannot work because they are disabled by replacing part of the salary they would be getting if they could work. But only those who are so disabled that they cannot work are eligible.

On the other hand, the unemployment program is focused on those who are ready and able to work yet find themselves without a job. Pennsylvania unemployment compensation law does not allow a person with a temporary disability to file a claim.

The law contains three mandates that exclude qualifying for unemployment due to medical reasons. A person seeking unemployment benefits must be:

  1. Physically able to work.
  2. Available for employment.
  3. Actively seeking a new job.

However, once a disabled person recovers from their injuries, they can file a claim for unemployment benefits. State laws may require a workplace accommodation for a person's disability.

Commuting Pennsylvania Residents

It may be easier for Pennsylvanians to obtain short-term disability benefits if they happen to work out-of-state. That is because two states that are close to Pennsylvania – New Jersey and New York – do mandate short-term disability benefits and base these mandates on where a person works rather than where they live.

That means that Pennsylvania residents commuting for work into these states can be covered.

New Jersey Requirements

New Jersey requires that individuals working in the state can get coverage for short-term disability to replace up to 85 percent of their lost salaries. Disability claim payments for this state's temporary disability benefits can last up to six months, depending on how long the individual remains under the care of a physician and remains unable to work.

Note that this applies only to those working in the state, so New Jersey residents commuting into Pennsylvania to work lose their right to disability benefits, while Pennsylvania residents commuting to work in New Jersey will be covered.

New York Requirements

This is true of New York, which also has a mandatory short-term disability program. Those commuting from New York to Pennsylvania lose out, while those commuting from Pennsylvania to New York can opt in.

But not all Pennsylvania commuters are as lucky. Pennsylvania residents traveling to Delaware, Maryland, West Virginia and Ohio are no better off than those working in Pennsylvania since these states do not have mandatory disability coverage.