What is the Difference Between FMLA and Short Term Disability?

If you are facing serious illness or injury that prevents you from working, you likely are considering your options for financial and employment protection.  It can be challenging to navigate the complexities of the Family and Medical Leave Act (“FMLA”) and short term disability benefits.  Understanding the intricacies of these benefits and how they interact is crucial to maintaining your financial stability and job security during challenging times.

In this article, we’ll provide a comprehensive guide on the key aspects of FMLA and short term disability, offering insight into who qualifies, how to apply, and the crucial steps to take if your benefits are unexpectedly denied.

What is the Family and Medical Leave Act (“FMLA”) and who qualifies for it?

The Family and Medical Leave Act (“FMLA”) is a U.S. federal law that grants eligible employees the right to take unpaid, job-protected leave for specified family and medical reasons.  The main intent behind FMLA is to help employees balance their work and family responsibilities by allowing them reasonable leave for certain family and medical reasons, without fear of losing their job.

Here’s who qualifies for FMLA:

• Employer Criteria: FMLA applies to public agencies, public and private elementary and secondary schools, and companies with 50 or more employees.  These employees must work within 75 miles of the worksite.

• Employee Criteria: To be eligible for FMLA leave, an employee must have worked for the employer for at least 12 months (not necessarily consecutively) and have clocked at least 1,250 hours of service during the 12 months prior to the start of the FMLA leave.

Employees can use FMLA leave for several reasons, including:

• The birth and care of a newborn child within one year of birth.

• The placement with the employee of a child for adoption or foster care within one year of placement.

• To care for an immediate family member (spouse, child, or parent — but not a parent “in-law”) who has a serious health condition.

• To take medical leave when the employee is unable to work because of their own serious health condition.

• Any qualifying exigency arising out of the fact that the employee’s spouse, child, or parent is a covered military member on “covered active duty.”

FMLA entitles eligible employees to take up to 12 weeks of leave in a 12-month period for most reasons, and up to 26 weeks to care for a covered service member with a serious injury or illness.  This leave can be taken all at once or can be taken intermittently as the medical condition requires.

What is short term disability insurance and who qualifies for it?

Short term disability (“STD”) insurance is a type of coverage that provides employees with a portion of their income if they are unable to work due to a qualifying disability, which can include illness, injury, or childbirth.  This insurance is designed to cover disabilities that prevent an employee from performing their job duties for a temporary period.  STD insurance is often offered by employers as part of a benefits package, but individuals can also purchase policies independently.

Qualification for short term disability insurance typically depends on the specific policy details set by the employer or the insurance provider.  Here’s a general outline of who qualifies:

• Employment Status: Most policies require that you are actively employed and working at the time you become disabled.  Some policies may have a specific minimum duration of employment before you are eligible.

• Waiting Period: There is often a waiting or “elimination” period that defines how long you must be disabled before you start receiving benefits.  This period can vary but commonly ranges from a few days to a couple of weeks.

• Medical Certification: To qualify for benefits, you typically need to provide medical proof of your disability, usually certified by a healthcare provider.  This documentation must show that your disability prevents you from performing your job functions.

• Coverage Scope: Policies define disabilities in different ways; some are very specific about what conditions are covered.  Commonly covered conditions include severe injuries, major illnesses, surgeries that require extended recovery times, and childbirth.

Short term disability benefits generally cover a significant portion of your income, usually between 50% to 100% of your regular salary.  Benefits are paid for a defined period, which can range from a few weeks up to a year, depending on the policy specifics.  It’s important to locate a copy of your full policy to determine the terms and conditions.

How Does FMLA Interact with Short Term Disability benefits?

When an employee qualifies for both the Family and Medical Leave Act (“FMLA”) and short term disability benefits, these two types of leave often operate concurrently.  This means that while FMLA provides job protection, allowing the employee to take up to 12 weeks of unpaid leave, short term disability can offer financial support during this time by paying a portion of the employee’s salary.  This arrangement helps ensure that employees maintain some income while also securing their job position during their leave.

The process of coordinating these benefits typically starts with the FMLA’s protections kicking in immediately when an employee takes leave for a qualifying medical condition.

However, short term disability (“STD”) benefits might have a waiting period before payments begin, which can create a gap.  During this gap, employees are protected under FMLA but may not receive income until the STD benefits start.  Employers often use the same medical documentation required for FMLA to process STD claims, which streamlines the approval process for both.

Moreover, if an employee’s disability extends beyond the FMLA coverage period, they may continue to receive disability benefits according to their policy’s terms, although without the FMLA’s job protection.  This situation underscores the importance of employees understanding how their STD benefits work, particularly how long these benefits last beyond the FMLA leave.

Employers generally manage the interaction between FMLA and short term disability by automatically designating qualifying STD leave as FMLA leave.  This integrated approach helps manage the duration of both types of leave but requires that employers clearly communicate these policies to ensure employees understand their rights and the extent of their coverage.  Such coordination is crucial for employees to effectively navigate their leave options while maintaining both financial stability and job security.

Can you receive short term disability benefits while on FMLA leave?

Yes, you can receive short term disability (“STD”) benefits while on FMLA leave.  This arrangement allows you to have a portion of your income covered through your disability insurance while also benefiting from the job protection provided by the Family and Medical Leave Act (“FMLA”).

When you are on FMLA leave for a qualifying reason—such as a serious health condition that prevents you from working—short term disability benefits can be activated if you have met the criteria set forth by your disability insurance policy.  This typically includes having a certified medical condition that incapacitates you from performing your job duties and fulfilling any waiting periods specified in the policy.

The concurrent use of FMLA and short term disability benefits is particularly beneficial because while FMLA protects your job, it does not offer paid leave.  Short term disability insurance fills this gap by providing financial support, usually a percentage of your regular income, during the time you are unable to work.  This dual benefit ensures that you can focus on recovery without worrying about financial instability or the security of your employment.

What are the key differences in protection and benefits between FMLA and short term disability?

The Family and Medical Leave Act (“FMLA”) and short term disability (“STD”) insurance provide different types of protections and benefits to employees.  Understanding these differences is crucial for effectively managing health-related absences from work.

• Purpose and Benefits: FMLA is designed to protect employees’ jobs during periods of absence due to personal or family health issues.  It allows for up to 12 weeks of unpaid leave per year for qualifying reasons, ensuring that an employee can return to their job or a similar position after their leave ends.  Short term disability, on the other hand, provides financial benefits, replacing a portion of the employee’s income during times when they are unable to work due to a medical condition.  However, it does not offer any job protection.

• Payment: FMLA does not provide any payment to employees while they are on leave; it only offers job protection.  Short term disability benefits usually cover between 50% to 70% of an employee’s salary, depending on the specific policy.  The payments are made during the disability period as defined by the terms of the insurance policy.

• Eligibility Requirements: To be eligible for FMLA, employees must have worked with their employer for at least 12 months and worked at least 1,250 hours during the 12 months prior to taking leave.  Additionally, the employer must have at least 50 employees within a 75-mile radius.  Short term disability eligibility, however, is generally determined by the terms of your insurance policy, which may or may not require a certain length of employment and usually includes a waiting period before benefits begin.

• Duration: FMLA leave is limited to 12 weeks within a 12-month period.  Short term disability coverage can vary significantly but typically lasts from a few weeks up to a year, depending on your policy’s terms and the nature of your disability.

• Conditions Covered: FMLA covers a broad range of conditions that require an employee to take time off to care for themselves or a family member, including childbirth, adoption, or foster care placement, and serious health conditions affecting the employee or their immediate family members.  Short term disability coverage is more focused on the employee’s medical condition that prevents them from performing their job duties.

By understanding these key differences, employees can better navigate their rights and options under both FMLA and short term disability insurance, ensuring they maximize the benefits available while protecting their job and income during periods of health-related absences.

How do you apply for FMLA and short term disability?

Applying for the Family and Medical Leave Act (“FMLA”) and short term disability (“STD”) involves distinct processes.  It’s important to understand how both operate to ensure you receive the necessary protections and benefits when you are unable to work due to a health condition.

When applying for FMLA due to medical leave, you should begin by notifying your employer of your need to take FMLA leave.  This should be done as soon as possible, ideally at least 30 days before the leave is expected to start if the need for leave is foreseeable.  Your employer may require you to submit a certification from a healthcare provider verifying the need for leave due to a serious health condition.  This documentation should detail the condition and the expected duration of the leave.  Your employer will likely provide you with specific forms to formally request FMLA leave.  These forms must be filled out and returned within the deadlines set by your employer to avoid delays.  Once your documentation is reviewed and approved by your employer, they will notify you of your FMLA leave eligibility and the terms of your leave.

Before filing your short term disability (“STD”) claim, review your policy to understand the eligibility criteria, benefits, and the process for filing a claim.  The policy is typically provided by your employer or the insurance provider.  The next step is notifying your employer and insurance company.  It’s typically best to inform both parties about your situation as soon as you realize you need to take disability leave.

You will need to officially submit your STD claim.  Complete the necessary claim forms, which are usually provided by your insurance company.  These forms require detailed information about your medical condition.  Along with the claim forms, you’ll need to submit medical evidence certified by your healthcare provider(s), detailing your diagnosis, treatment plan, and the anticipated duration of your disability.  Your insurance company will review your claim, which may include a review by their medical experts, to determine if you are eligible for benefits under the terms of the policy.

Both processes require timely communication and thorough documentation.  It’s important to closely follow your employer’s and the insurance provider’s procedures to ensure that you properly establish your eligibility and begin receiving benefits as soon as possible.  You may consider consulting with a disability insurance attorney with experience in ERISA.  They can help you navigate the STD claim process and maximize your chances of a successful outcome.

Are there any scenarios where FMLA is preferable to short term disability or vice versa?

When deciding between the Family and Medical Leave Act (“FMLA”) and short term disability (“STD”) insurance, it’s important to consider the specific circumstances of your leave.  Each provides different benefits and protections, making one more suitable than the other in certain situations.

• Job Protection with FMLA: If job security is your primary concern, FMLA is crucial as it guarantees that you can return to your job or a similar position after up to 12 weeks of leave.  This is especially vital in industries or roles where job continuity is critical.

• Family Care Needs: FMLA is also preferable when you need time off to care for a family member with a serious health condition.  Unlike short term disability, FMLA covers leave for caring for immediate family members, ensuring you don’t have to choose between family health and job security.

• Birth or Adoption of a Child: For parents dealing with the birth, adoption, or foster care placement of a child, FMLA provides essential leave.  This type of leave isn’t typically covered by short term disability policies, which focus on the employee’s medical condition rather than family support.

Conversely, there are scenarios where short term disability may be more beneficial:

• Income Replacement Needs: If replacing income during your medical leave is essential, short term disability is the better choice because it compensates a portion of your salary while you are unable to work due to your own health condition.

• Coverage for Extended Medical Conditions: Short term disability may be more suitable for conditions that incapacitate you but might not meet the FMLA criteria of a “serious health condition.”  This insurance is tailored to situations where your medical state directly affects your ability to perform job duties.

• Accessibility for Newer Employees: In some cases, short term disability insurance may have less stringent eligibility requirements compared to FMLA, which demands 1,250 hours of work and at least 12 months of employment with the same employer.

However, generally the best option is to combine FMLA and short term disability (if you are eligible for both).  Utilizing both FMLA for job protection and short term disability for income replacement can be an effective strategy during periods like medical surgeries and recoveries.  This ensures both financial stability and job security, allowing you to focus on recovery without the added stress of financial or employment uncertainty.

Carefully assessing the unique protections and benefits of both FMLA and short term disability will help you make the best decision to manage your health and employment needs effectively.  Speaking with an experienced disability insurance attorney can also help you decide the best path forward for your interests.

What happens if your short term disability lasts longer than your FMLA leave?

If your short term disability (“STD”) lasts longer than your FMLA leave, there are several implications to consider, as FMLA only provides job protection for up to 12 weeks within a 12-month period.  Here’s what typically happens:

• End of Job Protection: Once FMLA leave is exhausted, your job is no longer protected under the FMLA.  This means your employer is not legally required to hold your position open or guarantee that you can return to the same or an equivalent position.

• Continuation of Disability Benefits: If you are still unable to work due to your disability, your short term disability benefits may continue depending on the terms of your disability policy.  These benefits usually cover a set period which can range from a few months up to a year, providing financial support even after FMLA leave ends.

• Employer’s Leave Policies: Some employers may have additional leave policies that can extend beyond the FMLA requirement.  It’s important to review your company’s leave policies or discuss options with HR to see if additional protections or accommodations can be made based on company policy or under other laws like the Americans with Disabilities Act (“ADA”).

• Potential ADA Protections: If your condition qualifies as a disability under the ADA, you may be entitled to reasonable accommodations, which could include additional unpaid leave.  The ADA requires employers to provide accommodations that do not cause undue hardship to the business, so this might be an option if your disability requires more time off than FMLA covers.

Navigating the transition from FMLA to potentially longer-term disability considerations involves understanding your employer’s policies, the specifics of your disability insurance, and applicable federal laws like the ADA.  It’s beneficial to communicate openly with your employer and seek guidance from a short term disability attorney to explore all available options and protections.

Can employers require you to use FMLA leave before claiming short term disability benefits?

Employers can indeed require you to use FMLA leave concurrently with short term disability benefits.  This practice is quite common and allows the employer to manage leave and disability benefits more efficiently.  When an employee qualifies for both FMLA and short term disability due to a medical condition, the periods of leave can overlap, meaning that while the employee is receiving income support from the disability insurance, their job protection under FMLA is also in effect.

This requirement helps streamline the administration of leave and ensures that the employee uses up their federally mandated FMLA leave during the period they are also receiving disability benefits.  It prevents an employee from extending their total time off by taking FMLA and short term disability consecutively.  Additionally, using FMLA and short term disability leave concurrently can be beneficial to the employee as well, since it maximizes the period during which they receive both job protection and income replacement.

However, it’s important to understand your company’s specific policies on leave and benefits, as well as your rights under both FMLA and any disability insurance policy you have.  Employers should provide clear guidelines on how these benefits interact and the processes involved in applying for and using these types of leave.  

What should you do if you are denied short term disability benefits?

If you are denied short term disability (“STD”) benefits, it is crucial to first consult with an experienced disability insurance attorney.  An attorney with experience in ERISA can provide valuable guidance, help you understand your legal options, and represent you in dealings with your insurance company.

Here are some steps you can take if your short term disability claim is denied:

• Review the Denial Notice: Carefully review the denial notice to understand the specific reasons why your claim was rejected.  This notice should provide detailed explanations and pinpoint any deficiencies or missing documentation in your application.  Make sure to note any important deadlines for filing your appeal.

• Consult with an Attorney: While you do typically have the option to appeal the denial of your STD claim, the process can be challenging.  It’s always recommended that you speak with a disability insurance attorney who can best help you prepare a robust appeal and overturn your insurance company’s adverse determination.

• Gather Evidence: Collect all relevant documents related to your short term disability claim.  This includes medical records, statements from your healthcare provider(s), communications with your employer or insurance provider, and any forms you submitted.  Your attorney will be able to recommend additional evidence to support your claim and ensure all documentation supports your need for leave or disability benefits.

• File Your Appeal: Your attorney will be able to gather your evidence, including any additional documentation, and submit it to your insurance company along with a persuasive appeal letter refuting their reasons for denial.

Engaging an attorney early in the process is particularly important in navigating complex employment laws and insurance policies, ensuring that you take the most effective steps toward securing the benefits and protections to which you are entitled.

How Can The Maddox Firm Prove My Short or Long Term Disability Claim?

Successfully proving a short or long term disability claim requires thorough preparation and strategic handling.  At The Maddox Firm, our experienced team is committed to supporting our clients through each step of the claims process.  Our approach is designed to maximize your chances of a successful outcome by taking charge of the critical details and advocating relentlessly on your behalf.

Here’s how we can help:

• We Examine Your Policy and Assess Your Claim: We start by thoroughly reviewing your disability insurance policy to understand the specific coverage details and any potential limitations or exclusions.  This enables us to accurately assess your claim’s validity based on the policy terms and advise you on the best course of action.

• We Handle All Communications with Your Insurance Company: To ensure that there are no miscommunications that could potentially affect your claim, we take over all interactions with your insurance company.  This includes submitting the necessary paperwork and responding to any queries or requests for additional information.

• We Help You Obtain Evidence to Support Your Claim: Gathering comprehensive evidence is crucial to substantiate your disability claim.  We assist in compiling all necessary medical records, expert opinions, and other relevant documentation that clearly demonstrates the extent of your disability and its impact on your ability to work.

• We Handle Appeals and Litigation: If your claim is initially denied, we are prepared to handle the appeals process.  Our legal team will meticulously prepare your case for appeal, and if necessary, we are ready to represent you in court to pursue litigation.  We are committed to advocating for your rights and securing the benefits you deserve.

A short term disability or long term disability claim can be a complicated process.  If you need help during the claims process, with appealing a claim denial, or with litigating a final adverse short term or long term disability decision, The Maddox Firm can help.  The experienced team at The Maddox Firm will examine your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim.  Our New Jersey and New York long term disability attorneys help clients nationwide.

Contact us to help you file your claim, appeal, or litigation the right way.