Key Takeaways:

  • Short-term disability insurance provides wage replacement for periods when you cannot work because of an illness or injury.
  • The Family and Medical Leave Act provides unpaid, job-protected leave to eligible employees for certain purposes.
  • You can use short-term disability benefits to cover a percent of the wages you will not receive during FMLA leave.
  • Appealing a short-term disability claim denial can be a difficult process with strict deadlines. A skilled disability insurance lawyer can help.

When you’re hurt or sick and can’t work, figuring out your next steps can feel overwhelming. You might be worrying about your job, how to pay your bills, and what kind of help you can get. As frightening as this might seem, there’s good news: you don’t have to navigate this system alone. A disability insurance lawyer can be your guide through the process of claiming benefits. This article will help you understand your various options when your health keeps you from work. With our help, you can find your way through this tough time and make the best decisions for your situation.

Short-Term Disability Vs. Private Disability vs. Employee Leave

Whether it is a planned life event, a sudden illness, or an injury, an employee may need to take a leave from work. Employees considering taking a leave should understand the commonly confused short-term disability (STD) and Family Medical Leave Act (FMLA) benefits.

Short-Term Disability

Short-term disability is a wage replacement benefit, not a form of employee leave.

  • Short-term disability benefits provide income replacement when an employee cannot work for a limited period.
  • Employers may offer short-term disability insurance as a benefit along with health insurance and other types of coverage.
  • Short-term disability insurance coverage can last from a few weeks to upwards of 52 weeks, depending on the policy. The average amount of coverage is about 180 days.
  • Although short-term disability is a wage replacement benefit, employees typically only receive 40 to 60 percent of their regular wages.
  • Unlike other forms of employee leave, short-term disability benefits do not have guaranteed job protection, and continuing health insurance coverage is not assured.
  • Eligibility for short-term disability benefits does not affect eligibility for FMLA leave.

Some employers might only offer long-term disability insurance, particularly in states that have state-run short-term disability insurance funds. New York State, for example, has its own program.

Our firm does not handle state-based short-term disability claims.

Private Disability Insurance

Private disability insurance is similar to automobile insurance in the sense that you deal directly with the insurance company to purchase coverage for yourself. You pay the premiums monthly, every six months, or yearly for an individual disability policy. The policy states that if you become disabled, the insurance company will pay you a specific amount per month.

Employee Leave and Family and Medical Leave Act (FMLA)

Pregnant woman on FMLA or Family medical leave

FMLA (Family and Medical Leave Act) is a federal law that provides up to 12 weeks of unpaid, job-protected leave from work for eligible employees. The law only applies to covered employers that have at least 50 employees within 75 miles. To be eligible for FMLA leave, an employee must have

FMLA Employees Requirements

  1. Worked at least 1,250 hours over the last year; AND
  2. Been employed with the company for 12 months or more.

Employers must restore the employee to the same or comparable position within the organization once the employee returns from leave.

Eligible employees may use FMLA for the following purposes:

  • The birth of a baby
  • The adoption of a child
  • To care for an immediate family member who has a serious medical condition
  • To recover from their own serious health condition

Disabled employees can also take leave under the Americans with Disabilities Act (ADA). Employees may need to take ADA leave if they have exhausted their FMLA benefits or do not meet the eligibility criteria. Unlike FMLA leave, ADA leave times are case-specific and determined as reasonable accommodations for the disabled worker. Employers do not have to maintain an employee’s benefits during the leave period.

Short-term disability benefits can overlap with ADA or FMLA leaves. They can replace the wages you will not receive while on leave. This can help ease your financial burden when the unexpected arises.

How Much Does Short-Term Disability Cover?

Short-term disability typically covers 40 to 60 percent of your regular pay. It is subject to a time limit, which is often around 180 days.

The Short-Term Disability Appeal Process

infographic displaying short-term disability graphics


The route you must take to litigate or appeal a disability claim denial will depend on whether you have a private disability insurance policy or one governed by ERISA.

Private Insurance Policy

The process for appealing a denial from a private insurance policy is not as formalized as an appeal from an employer-provided policy since federal law does not govern the process. Each insurance company may have their own set of procedures outlined in their disability insurance policies. The process generally includes the following steps:

  • Notify the insurance company of your appeal.
  • Review your insurance company’s procedures for appeals.
  • Gather information to support your disability claim.
  • Submit an appeal with supporting documents, including medical records and support statements from family members and others.
  • Argue the case, either in a hearing or through written submissions.
  • File a lawsuit if necessary.

Employer-Provided Insurance Policy

ERISA limits how you may appeal a denial of coverage from an employer-provided insurance policy:

  • You must file an appeal directly with the insurance company within 180 days of the denial.
  • You may not file a lawsuit until you have gone through every possible administrative process.
  • If you file a lawsuit, you cannot present any evidence that you did not present during the appeal to the insurance company. Therefore, you must have your entire case ready within 180 days.

The appeal process under ERISA includes the following steps:

  1. Review the denial letter from your insurance company, which gives specific reasons for the denial.
  2. Review your insurance company’s procedures for appeals. Any mistake, however small, could result in loss of benefits.
  3. Obtain a copy of your claim file. See if any important information is missing.
  4. Request medical records that can supplement your file. Send those records to the insurance company.
  5. Submit an appeal to the insurance company before the deadline.

If the insurance company denies your appeal, it must send you a letter explaining why. You may then be able to file a second appeal or file a lawsuit.

Why Our Clients Trust The Law Office of Justin Frankel

The Law Office of Justin Frankel has recovered more than $250 million in compensation for its clients. Our firm has received recognition in Super Lawyers every year for the past decade and has an average rating of 4.9 stars on Google. ADD Martindale-Hubbell® has rated Mr. Frankel an AV® Preeminent Peer Review Rated, the highest possible designation from Martindale-Hubbell. Super Lawyers has named Mr. Frankel to its select list of attorneys for the 2011-2023 New York Metro listings.

Client Testimonials

“A little over 4 years ago, a friend recommended Justin to me and my family. At the time, I was concerned and confused about the situation we were in, what options I had, and how to proceed. Justin handled everything from day one, walked me through the process, and has handled everything ever since. You will never meet a more dedicated and honest person. He is always available to answer any questions or concerns, he sincerely cares about my case, and he continues to go above and beyond even 4 years later. We couldn’t be happier with Justin Frankel. He is simply the best in his field.” — Marie N.

Navigate Your Disability Leave With Confidence

The Law Office of Justin Frankel has helped people navigate the complex world of disability insurance appeals for over twenty years. As a client, you will work directly with a top partner. To schedule a free consultation or receive a copy of our free ebook, contact the firm today by calling 888-583-4959 or filling out the online contact form.

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