Can You Use FMLA and Short-Term Disability Together?

Can You Use FMLA and Short-Term Disability Together?

There are two major concerns when you are dealing with a health condition that has become disabling. First, you want time off from work to get the continuing medical treatment you need to recover. Second, if you have the coverage, you also want to be paid a portion of what you made before you became disabled. This way, you can meet many financial obligations, even without working.

Some solutions can support you through this challenging time, allowing you to take work leave while putting money in your pocket:

• The Family and Medical Leave Act mandates that your employer allow you a certain amount of time for leave each year to get treatment for yourself or to take care of an ill family member. Both you and your employer must meet specific criteria to qualify for protection under the law.
• Short-term disability insurance is either provided by your employer as a benefit or is privately purchased. This policy will cover some of the lost earnings you made before becoming disabled.

If you need to take FMLA time and seek short-term disability, always discuss your best options with a Louisiana disability attorney first.

You Can Take Medical Leave While Receiving Short-Term Disability Insurance Benefits

You do not have to make a linear choice between using leave under the FMLA and filing for short-term disability benefits. You can use both simultaneously because a health condition can meet both criteria. One entitles you to leave from work, while the other may allow you to replace some of the income you were earning.

To understand why you can use FMLA leave and short-term disability together, you should know how each works because they have significant distinctions.

Overview of the Family and Medical Leave Act

The FMLA allows workers to take leave from work for personal or family health reasons. The FMLA defines a covered condition as an illness, injury, impairment, or physical or mental condition involving inpatient care or continuing treatment by a health care provider.

Employees can take 12 weeks of unpaid leave in 12 months and keep their job and health insurance coverage. So long as the purpose for the leave meets FMLA criteria, the employer cannot fire them. Employees may take time off when they have severe health conditions that prevent them from doing their jobs and can also use this leave to care for a covered family member. For example, you can use FMLA leave for the birth of a child, regardless of whether you are the mother or the father.

When You May Be Eligible for FMLA Leave

The requirements to be eligible for leave under the FMLA are:

• You work for an agency or public company with at least 50 employees.
• You have worked for the employer for at least 12 months.
• You have logged at least 1,250 work hours in that year before needing to use the leave.
• You work at a location with at least 50 employees within 75 miles.

Individual states also have laws similar to the FMLA but cannot pass a more lenient law because the federal law will then preempt it. However, states may pass laws that impose even more protections for employees. Then, you can sue your employer under state law to recover damages when they refuse to grant you leave to which you are entitled.

Overview of Short-Term Disability

Employers may provide their employees with short-term disability insurance coverage (or employees may purchase it independently). Employees will receive a percentage of their earnings (usually between 40-70 percent) when they meet the plan’s definition of “disabled.” Here, it means that they cannot perform their job duties. Short-term disability coverage usually lasts up to six months; then, you will apply for long-term disability coverage. Even though your plan promises you the benefits when needed, insurance companies often make the process challenging.

The Intersection of FMLA and Short-Term Disability

The fact that you qualify for FMLA does not automatically mean you will qualify for short-term disability benefits. First, if you were using FMLA leave to care for someone else, you should not be allowed to claim short-term disability benefits for yourself. Perhaps your family member can file for short-term disability benefits, but you cannot since you are not the one who is disabled.

Qualifying for short-term disability benefits depends on whether you can meet your policy’s definition of the term “disabled,” where you must be the one who is unable to work.

If you take the FMLA leave for your medical condition, you can file for short-term disability benefits, and everything depends on your situation. For a short-term disability policy, you must prove that you cannot handle the duties of your occupation due to your condition.

Further, you must prove that your medical condition was not pre-existing and did not result from a work-related injury. If you suffered an injury on the job, you must proceed through workers’ compensation, the exclusive remedy for workplace injuries.

Key Differences Between the FMLA and Short-Term Disability

The critical difference between short-term disability and FMLA is that the latter involves leave from work, while the former requires payment to you. You may take time off, but it will be unpaid when the FMLA applies. When you qualify for short-term disability benefits, you will receive compensation at a fraction of your salary while away from your job.

While both FMLA and short-term disability involve some protection for employees, there are several key differences between the two:

• The FMLA protects your job, allowing you time off for your medical condition. Short-term disability does not offer this protection, and your job may be at risk when receiving short-term disability benefits.
• The FMLA allows you to take time off from work, while short-term disability benefits provide you with some replacements for the income that you would have earned.
• Short-term disability benefits are limited to your condition, while FMLA leave allows you to care for others besides yourself.
• You can qualify for short-term disability benefits when working for as little as 90 days. You must have been on the job for your employer for at least 12 months to be protected by the FMLA.
• There are different procedures to apply for short-term disability than seeking approval for FMLA leave.

Short-Term Disability Means That You Are Dealing with an Insurance Company

Perhaps the most significant difference between the two is that you are dealing with a private insurance company when you are seeking short-term disability insurance benefits. Insurance carriers often have no relationship with you because your employer pays the premiums, and there is a strong chance they will deny your claim, forcing you to sue. You must proceed under the ERISA procedures if your policy was part of an employee benefit. If you purchased the policy alone, you can sue the insurance company in state court for breach of contract.

With FMLA, you are dealing with your employer, and they are not paying you for time away unless you have paid sick leave. Even if they attempt to hire someone else for your job, you have relatively substantial protections under state law. While you may have to appeal to insurance companies if they deny your short-term disability claim, you can directly sue your employer if they wrongfully deny you FMLA leave.

Insurance companies may make it difficult, in general, to qualify for short-term disability benefits. Your employer should be more straightforward because they fear federal enforcement action or a lawsuit. However, some employers may ride the line of compliance, and in some cases, they may cross it.

Lawsuits for Violations of the FMLA

If your employer violates the FMLA, you may file a private lawsuit against them in court, and by proving they broke the law, you may receive financial reimbursement for the following damages:

• Back pay for what you will have earned in the past
• Future pay if you lost your job or your ability to work was harmed
• Other damages for the emotional harm and stress that you suffered
• Court fees and attorney’s fees
• Additional costs, such as caregiver expenses for your loved one if you had to incur them

In addition, you may also consider filing a complaint against your employer with the Department of Labor or the relevant state regulatory agency. The government can also take civil enforcement action against your employer, including issuing a hefty fine. You can complete a complaint form online, and the Department of Labor will decide whether to investigate your employer.

Filing Lawsuits for Denied Short-Term Disability Insurance Claims

You have legal options to fight back when the insurance company denies your short-term disability claim. If your plan was part of an employee benefit, you must follow the ERISA appeals procedure, which will first go through the insurance company. You need to take this part of the process seriously, even if you know with almost near certainty that the insurance company will deny your appeal, and you will take your case to a federal district court when it is.

A federal judge will review the file before the insurance company to determine whether it made a mistake by denying you benefits. The legal process can be a challenging and lengthy fight for which you need an experienced attorney.

If your disability insurance was a plan you purchased individually, you can sue the insurance company directly without going through the appeal process first. Your case will likely be in state court on a breach of contract legal theory.

Why You Need a Short-Term Disability Attorney

If you are disabled, you need the benefits that short-term disability insurance provides. However, insurance companies rarely promptly approve and disburse these benefits. Despite a legitimate claim, insurance companies may employ various tactics to make the process more difficult.

Insurance companies commonly require extensive documentation, and even minor errors or omissions can result in claim denials or delays. The burden of proof falls on you to establish your eligibility, leaving room for insurers to exploit technicalities or ambiguous policy language.

Delays in processing claims are another common hurdle. Insurance companies may intentionally prolong the evaluation period, making it frustrating for you when you rely on these benefits for financial stability during your disability.

Furthermore, insurers may request additional medical examinations or assessments by their chosen healthcare professionals to contest the severity of the disability. These examinations may not always align with your treating physician, creating discrepancies they can use to dispute the legitimacy of the claim.

Navigating the appeals process after a denied claim can also be challenging. Insurance companies may employ internal review procedures that seemingly favor their interests, making it crucial for you to seek legal counsel to challenge unjust denials.

In response to these challenges, anyone seeking short-term disability benefits should meticulously document their condition, adhere to all requirements outlined in the policy, and always enlist the assistance of an experienced disability attorney. Disability attorneys can protect your rights, assist in gathering necessary documentation, and navigate the difficult process of appealing denied claims.

Depending on your specific situation and needs, an experienced disability attorney can do the following and more:

• Collect and compile the information necessary to file a persuasive claim.
• Communicate with the insurance company during the claims process, keeping you from making a mistake and the insurance company from trying to trap you.
• Review the reasons why the insurance company may have denied your claim to submit an appeal.
• Build a substantial appeal file that addresses the reasons for your claim’s denial.
• Take your case to federal court if and when the insurance company denies your appeal.

While insurance companies may make the process difficult, the right disability lawyer can handle everything for you and relieve your stress about the matter.

You Do Not Have to Pay Upfront for a Short-Term Disability Attorney

If disability benefits are involved, you should consider hiring an attorney to help with your claim and pursue an appeal if necessary. A disability benefits attorney will not charge you for their services upfront; you only have to pay them if you win your case. If you want to beat insurance companies at their own game in an appeal, you need a lawyer who knows the process and how to fight back.