Workers are injured all the time, both at work and outside. In 2009, the Bureau of Labor Statistics reported 1,238,490 cases of injury or illness in the United States that required days to recover before work. In addition, according to the Social Security Agency, a 20-year-old worker has a 30 percent chance of becoming disabled before reaching retirement age.
If an employee is injured or becomes ill as a direct result of their work, that employee is entitled to employee compensation with weekly cash benefits and medical care fully covered by employers’ insurance. However, if an employee suffers from an unrelated illness or injury that specifically prevents them from doing their job – this is most often the case with a disability claim – the employee may be entitled to short-term or long-term disability benefits.
“Some of the best conditions [that compel people to apply for disability] include heart problems, diabetes, fibromyalgia, chronic fatigue, carpal tunnel, knee problems, and difficulty standing for long periods of time, “says Linda Nee, a licensed health advisor and disability claims expert based in West Newfield, Maine.” In essence, when a person is unable to perform the material and essential duties of their profession, because of those policies they are disabled. “
Companies typically buy group disability insurance policies for their entire company. However, when the time comes to resolve an employee’s disability claim, it is important to be familiar with the employer’s process and actions. This guide covers the duties and responsibilities of the employer in processing a disability claim for an employee.
Dealing with a disability claim: preparation
“If you work for a company, your employer has likely bought a policy for you and pays premiums for the policy. If you get sick and can’t work, you have an income replacement,” Nope says.
If you have a start-up and currently cannot afford group insurance, notify your employees and advise them to take out private insurance if they wish. However, most companies buy group insurance from the major US insurers such as Cigna, Unum, Aetna, MetLife and Prudential.
Be realistic but careful when considering which insurance policies to buy – short term, long term, or both. Buy only what you think your business needs. Take into account the size of your company and the routine exposure to your office environment. For example, if you are a cubicle office whose biggest potential threat is the stapler, short-term insurance may be all you need. However, if your business works outdoors, or if your employees deal with both deadly snakes and tarantulas, for example, this long-term insurance policy is likely worth it.
While companies buy and own these insurance policies, employers have no control over who receives disability benefits. A third party administrator – regardless of which insurance company you have selected, e.g. B. Aetna – is responsible for reviewing claims and delivering decisions.
Dig Deeper: Corporate Insurance Budget
Dealing with a disability claim: application
Know what types of services your affected employee qualifies for. If the injury, illness, or disability is severe enough, your employee may qualify for Social Security disability insurance.
“Social insurance [Administration’s] Definition of disability is that you do not have to be able to work permanently in a job five days a week, hours a day, “says Stephen Jackel, a New York City-based lawyer for the disabled.” It differs from private disability insurance; Social security is broader. You don’t have to be able to work in just any job, not just your previous job. “
However, if the injury or illness is less permanent and temporary, the employee will have to complete an application process, which will require the insurer to consider the help of the employer or the staff representative.
Insurers require three separate forms to consider employees for disability benefits: one form must be completed by the employee concerned, another form by the employer, and a third form by a doctor or practicing physician.
Successful short-term disability applications can expect payments within 14 days. Disease decisions typically take longer as insurance companies need to collect and confirm evidence that the disease is serious and significantly disabling.
Digging Deeper: The Disabled Advantage
Dealing with a disability claim: continuation / termination
Long-term disability insurance covers employees between the ages of two and five or up to the age of 65. After this period, an employer can choose whether to keep or terminate the person’s employment. On the other hand, employees with a short-term disability can only receive benefits for 12 weeks in a 12 month period. During these 12 weeks, the Family and Sick Leave Act stipulates that employers must keep the employee’s job and continue to pay benefits.
“This is very helpful for employees who have surgery and who have to be absent, and for employees who know they’ll be back to work because they can get back to work and have no performance degradation.” Says no.
At the end of these 12 weeks, the employers contact the employee and ask if they can work again. If the employee cannot return by the end of these 12 weeks, the employer can fire the employee with the blessing of the federal government. Employers are not legally required to continue paying benefits after these 12 weeks, and most of them choose not to. For employers, this means the end of the disability claims process.
Digging Deeper: How to Fire an Employee
Dealing with a Disability Claim: A Note on the Complaint
Employees will not always win their disability claims. While the employer does not need to be present for the subsequent tug-of-war between the employee and the insurance company, you can certainly help your employee advise on what to do next.
Complaints are usually handled administratively. If the employee wants to appeal, recommend that your employee contact the state office for disability assistance. Individuals have 180 days to appeal their decision on disability claims. However, you are strongly advised not to go a step further and take the claims to court – especially for minor claims.
“A lot of insurance companies just sit back and use up the American middle class because they know these policies aren’t very good,” Nee says. “The laws don’t support the insured. Moreover, lawyers won’t even take the cases unless the policy is over $ 3,000 to $ 4,000 a month. They just won’t. It’s not worth it.” They are not moneymakers. “