In employment law terms, a disability is a medical condition which prevents a person from working for a period of time. Depending on the condition, the disability benefits provided by the employer or insurance may cover all or some of the lost income. It may also cover other medical expenses; this coverage is generally based on the person’s income in the past year.
Disabilities, in an employment context, are categorized as either “short-term” and “long-term.” Examples of long-term disabilities may include:
- Illnesses lasting for many months, or longer;
- Chronic conditions;
- Conditions that recur over time; and/or
- Serious emotional or mental symptoms.
Insurance companies and state disability programs often maintain differing criteria for determining what constitutes a long-term disability, as opposed to a short term disability. State laws may also vary in terms of disability definitions and applications.
A short-term disability is any disability that is temporary in nature, and may allow the injured employee to return to work after a recovery period. In general, these disabilities are usually moderately serious and non-threatening injuries or illnesses. Some examples of conditions or injuries that could constitute short-term disability status include:
- Injuries which require surgery;
- Sprains or muscle strains;
- Minor fractures or broken bones;
- Specified illnesses; and
- Various kinds of on-the-job injuries.
Generally speaking, in order for an injury to be considered an “on the job injury,” it must arise out of the employment and must occur during the course of employment.
What this means is that the injury must have happened at the work site, and during a period of employment. Additionally, there should be evidence of some sort of relationship between the injury and the job description.
There are three classifications of on the job injuries:
- Specific Events: Specific events are a one-time event or trauma, such as when a construction worker falls off of a ladder;
- Cumulative Trauma: Cumulative trauma is caused by repetitive movement or work, such as developing carpal tunnel syndrome due to excessive typing or losing hearing as a result of working with very loud machines; and
- Occupational Disease: Occupational diseases are diseases caused by being exposed to substances at work, such as lung disease caused by asbestos exposure.
What Is the Difference between Total vs. Partial Disability?
Sometimes, short-term disabilities may involve only a partial disability. This allows the employee to work part-time, or in a limited capacity.
Partial disability is defined as any type of disability in which the employee is unable to perform at their full physical capacity. Such disabilities are commonly due to an on the job injury, or an illness. A total disability, on the other hand, is one in which the employee is prevented from performing any work at all. This is directly because of the injury or condition. Generally speaking, total disability is defined as the loss of the use of both:
- Hands; or
Another definition of total disability would be the loss of the use of any two such parts, such as a leg and an arm. Total disability may also involve impairment due to a serious occupational disease.
Can I Receive Benefits for Short-Term Disability?
Depending on the circumstances of each specific situation, it is possible to receive benefits for short-term disability. Generally, short-term disability is covered by the employer or through private insurance companies. Employees are also sometimes provided with the option to purchase their own disability packages.
Most state and federal social security disability insurance programs only cover long-term or permanent disabilities. However, there are some states which maintain laws requiring employers to provide some form of short-term disability options. These states include Hawaii, New Jersey, and others. Short-term disability benefits typically include paid time off and some reimbursement for lost wages.
In terms of collecting disability payments or damages awards, there are significant differences between total and partial disability. For those experiencing partial disability, the legal remedies most commonly include compensation for lost wages due to the injury. However, this sometimes results in lower pay rates for the worker, as they may still be able to work but are not able to perform as before.
Total disability can also result in compensation for lost wages. Additional damages may be awarded for issues such as the loss of future earnings, or lost earning capacity. Because a person experiencing total disability generally cannot perform any work, they may be entitled to these types of damages as well. In especially serious cases, loss of future earnings may be claimed for a partial disability.
A disabled worker may be paid disability benefits if they suffer “loss of the use of a part of the body” directly because of the work-related injury. In an employment law context, “loss” generally refers to an inability to use the body part in the same way as before the injury occurred.
What If I Have a Dispute Over Short-Term Disability Issues?
One of the most common disputes regarding short-term disability would be the denial of benefits. Such claims are generally denied for one of three reasons:
- The applicant’s condition is not covered by short-term disability, as some policies offer benefits for a specific condition but others do not;
- There was not a sufficient amount of medical evidence provided; and
- The insurer or other party providing short-term disability benefits denies the claim because they believe the claimant is lying about their condition.
Denials may sometimes be appealed. In the case of short-term disability benefits that are provided by an employer, applicants receive protections under “ERISA.” The Employment Retirement Income Security Act is a federal law which governs pension and retirement for private sector employees. Under ERISA, there is a set process for appealing denials.
Generally speaking, the appeals process is as follows:
- Review Denial Letter: If your short-term disability claim has been denied, you will receive a letter stating as much. You should carefully review this letter in order to determine why your claim was denied, as well as how to move forward with an appeal and what deadlines you must meet;
- Review Your Policy: If your denied benefits were to come from an insurance policy, it is important to carefully review this policy before moving forward. There may be language contained within the policy that prohibits you from taking certain actions. This will reduce the possibility of making further mistakes that could negatively impact your case;
- Request Your Administrative Record: Your administrative record consists of the medical records and any other evidence you provided to the insurance adjuster, or the party responsible for reviewing your claim. You will want a copy of this record so you may supplement it with additional evidence, as this record is the only information that may be considered during the formal appeal;
- Submit Written Appeal: Generally speaking, an appeal must be in writing; it cannot be as simple as a phone call made to your insurance company. Your written appeal should detail all factual legal arguments you may have against their denial; and
- Seek Legal Help: If you are further denied, you should consult with an attorney who specializes in short-term disability benefits. The appeals process is complicated, and an attorney can help ensure you complete the necessary steps.
Disputes may involve multiple parties, such as employers and third-party insurance providers. The involvement of multiple parties further complicates the issue. Some common remedies for disputes involving short-term disabilities include a damages award for lost wages, or a renegotiation of contract terms.
Do I Need a Lawyer for Help with Short Term Disability Issues?
You should consult with a local workers compensation lawyer if you are facing any disability or employment issues. Because disability laws vary from state to state, an experienced and local employment attorney would be best suited for understanding your state’s laws and how they will apply to your case. An attorney can also help you with filing a claim or an appeal. Finally, an attorney can represent you in court as needed, and ensure that your legal rights are protected.