Is COVID Covered Under Short-Term Disability?

Short-term disability (STD) offers a financial safety net, providing a percentage of an individual’s pre-disability earnings on a weekly basis when they are temporarily unable to work due to a non-work-related illness or injury. This income replacement helps cover living expenses during a period of medical absence. Understanding how these benefits function, especially in the context of conditions like COVID-19, can help individuals navigate health challenges.

General Short-Term Disability Requirements

To qualify for short-term disability, the condition must be a non-work-related illness or injury, as workplace incidents are covered under workers’ compensation. Medical documentation from a licensed healthcare professional certifying the individual’s inability to perform the essential functions of their job is required. This certification establishes that the individual is incapacitated and unable to work.

Most short-term disability policies include an elimination period, also known as a waiting period, which is the duration between the onset of the disability and when benefit payments begin. This period commonly ranges from seven to thirty days, with fourteen days being a frequent standard. Individuals often use accumulated sick leave or vacation time to cover income during this initial waiting period. The definition of “disability” under these policies means being unable to perform one’s own occupation.

COVID-19 and Eligibility Criteria

A COVID-19 diagnosis can meet the eligibility criteria for short-term disability benefits. The critical factor is medical documentation from a healthcare provider confirming that the illness prevents the individual from performing their job duties. This documentation should detail the severity of symptoms, any necessary isolation periods, and how these factors incapacitate the individual. For instance, symptoms such as severe fatigue, respiratory issues, or other debilitating effects can significantly impair an individual’s ability to work.

Eligibility for short-term disability due to COVID-19 also extends to cases of “long COVID,” where symptoms persist for an extended period after the initial infection. Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), is recognized as a potential disability under federal guidelines if its symptoms substantially limit major life activities. Medical records are important in these situations, demonstrating the ongoing nature of the condition and its impact on the individual’s functional capacity. The specific terms of an individual’s short-term disability policy, whether employer-provided or private, ultimately govern the extent of coverage.

The Short-Term Disability Claim Process

Individuals should gather all relevant medical records, including diagnostic test results, treatment notes, and statements from their treating physicians that detail the diagnosis, limitations, and expected recovery period. It is also necessary to have personal employment information readily available, such as the last day worked, job duties, and salary details. The short-term disability policy number, if applicable, should be on hand, and claim forms can typically be obtained from the employer’s human resources department, a benefits administrator, or directly from the insurance provider.

Once all required information and documents are prepared, the submission of the claim can proceed. The individual generally contacts their employer’s HR department or the benefits administrator to begin the process. Claims can often be submitted through online portals, via mail, or by fax, depending on the insurer’s capabilities. After submission, the insurance company typically assigns a benefits specialist to review the claim. This review includes verifying the medical certification and employment details.

Understanding Your Benefits

Upon approval of a short-term disability claim, benefits are typically calculated as a percentage of the individual’s pre-disability income. This percentage usually ranges from 40% to 70% of weekly earnings, though some policies may offer up to 80%. For example, if an individual earns $1,000 per week and their policy covers 60%, they would receive $600 per week in benefits. Policies may also specify a maximum weekly benefit amount, regardless of the income percentage.

The duration of short-term disability benefits is temporary, with typical benefit periods ranging from 9 to 52 weeks. Many plans commonly provide benefits for 13 to 26 weeks. Payments generally begin after the elimination period has been satisfied. These benefits are designed to provide financial support during a temporary period of incapacitation, bridging the gap until an individual can return to work or potentially transition to long-term disability if the condition persists.