MANDATORY SHORT TERM DISABILITY BENEFITS

Am I Eligible?

Employers are required by New York law to provide short term disability [“STD”] insurance coverage. If you: (1) were employed for at least four weeks at the time you became disabled; (2) became disabled within four weeks after leaving your last job; or (3) were collecting unemployment insurance benefits at the time you became disabled, you may be eligible to collect STD benefits.

What Should I do?

Apply for these benefits as soon as possible. A claim can be started by completing the appropriate form. The form requires information from you and your doctor.

If you were employed at the time you became disabled, complete form DB-450. That form is available from your employer or at:
http://www.wcb.ny.gov/content/main/forms/db450.pdf

If you became disabled within four weeks after you left your last job, or if you were collecting unemployment insurance benefits at the time she became disabled, complete form DB-300. Find that form at http://www.wcb.ny.gov/content/main/forms/db300.pdf

How Much is the STD Benefit and How Long Does it Last?

You can collect a weekly benefit equal to 50% of your weekly wage or $170.00, whichever is LESS. There is a one week waiting period. You can collect STD benefits for up to 26 weeks. There are no associated medical benefits. STD benefits are taxable.

Can I collect Unemployment Insurance [“UI”] and STD benefits?

You can collect up to 26 weeks of unemployment insurance OR STD benefits. You CANNOT collect 26 weeks of BOTH types of benefits.

Will Receipt of these STD Benefits Affect Social Security Disability [“SSD”] benefits?

No. SSD benefits do not start until AFTER STD benefits stop.

GROUP “ENHANCED” SHORT TERM DISABILITY BENEFITS

Am I Eligible?

If you were employed at the time you became disabled, you may be eligible for group “enhanced” short term disability benefits (which exceed the mandatory STD benefit discussed above).

These benefits are provided pursuant to a written agreement which will often define important terms such as “disability.” Employers are NOT required to provide these benefits, however, many larger employers do so. These benefits are generally taxable.

What Should I do?

You should contact your employer immediately, get the appropriate claim form and complete it as soon as possible.

Do not rely on oral representations by human resource/employee benefit staff who work for your employer. Request a copy of the disability benefits insurance policy/plan and read it. Request a copy of the Summary Plan Description (lay person’s description) and read it.

How Much is the STD Benefit and How Long Does it Last?

Most STD policies pay a certain percentage of your “pre-disability” compensation (usually anywhere from 40% to 70%) MINUS you receipt of other benefits such as Workers’ Compensation. Most STD benefits last up to 26 weeks from the date you became disabled.

Will Receipt of these STD Benefits Affect Social Security Disability [“SSD”] benefits?

Usually not. Typically, SSD benefits do not start until AFTER STD benefits stop.

GROUP LONG TERM DISABILITY BENEFITS

Am I Eligible?

If you were employed at the time you became disabled, and if your disability has lasted (or is expected to last) 26 weeks or more, you may be eligible for group long term disability [“LTD”] insurance benefits.

These benefits are provided pursuant to a written agreement which will often define important terms such as “disability.” Employers are NOT required to provide these benefits, however, many larger employers do so. These benefits are generally taxable.

What Should I do?

You should contact your employer immediately, get the appropriate claim form and complete it as soon as possible.

Do not rely on oral representations by human resource/employee benefit staff who work for your employer. Request a copy of the disability benefits insurance policy/plan and read it. Request a copy of the Summary Plan Description (lay person’s description) and read it.

How Much is the LTD Benefit and How Long does it Last?

Most LTD policies pay a certain percentage of your “pre-disability” compensation (usually anywhere from 40% to 70%) MINUS you receipt of other benefits such as Workers’ Compensation or SSD.

If you continue to be disabled within the meaning of the LTD policy, you usually can collect until your full Social Security retirement age (which depends on your date of birth). If you first become disabled less than five years before your full Social Security retirement age, most LTD policies provide that you are eligible to collect for a full five years.

Will Receipt of LTD Benefits Affect Social Security Disability [“SSD”] benefits?

No, however, the opposite is true. The amount of your LTD benefit often is REDUCED by the amount of SSD benefits paid to you AND your minor children.

Do I get a full LTD benefit while I am waiting for SSD?

Yes, but ONLY if you promise in writing to pay any lump sum that of back SSD benefits to the LTD insurance carrier. Thus, and after you are approved for SSD, you usually will receive at least as much money monthly as you received from the LTD carrier, however, it will come from two sources (the LTD carrier and Social Security).

I heard the LTD carrier pays your fee if we win the SSD case. Is that true?

Yes. The LTD carrier knows that your chances of winning your SSD case are greater if you are represented by a lawyer. For that reason, they typically pay our fee and supply us with medical records that they have secured regarding you.

We are prohibited by law from paying out-of-pocket expenses incurred to prosecute your claim. In the past, the most significant expense was the cost charged by doctors to secure your medical records (75 cents/page). Recently, New York passed a law which prohibits doctors from imposing this charge when a person is requesting them to apply for public benefits like SSD. Thus, we expect to incur virtually no expenses for which you will be responsible.

I’m confused. Can you give me an example?

Sure, consider our client “Wendy.”

Wendy was approved for LTD benefits through her employer’s policy at the rate of $2,000/month. Her estimated SSD benefit was $1,500/month.

The LTD carrier agreed to pay her $2,000/month while she waited for her SSD case to get resolved. They did so because Wendy promised in writing that she would pay to the LTD carrier any lump sum of SSD benefits that she received.

Wendy ultimately was approved for SSD. Her SSD lump sum, before our fee, was $10,000. Social Security approved us for a $2,500 fee (25% of the SSD lump sum).

Wendy paid to the LTD carrier the $7,500 lump sum that she received from Social Security ($10,000 minus our $2,500 fee). The LTD carrier gave her a $10,000 credit, that is, she was NOT required to “come out of pocket” to pay our fee. Thus, the LTD carrier paid our fee. Wendy remained responsible for paying the out-of-pocket expenses we incurred in her case.

Going forward, Wendy still collected $2,000/month–Social Security paid her $1,500/month and the LTD carrier paid her $500/month.

What if the LTD carrier does not pay me? Can I sue them?

Most disputes concerning group LTD policies are subject to a federal pension law (ERISA) and its “arbitrary and capricious” standard of judicial review. This is a VERY difficult standard to meet.

HEALTH INSURANCE

Maintaining health insurance coverage–and getting appropriate medical treatment–is very important, particularly until you are eligible for Medicare. We encourage you to explore whether you are eligible for “affordable” health insurance coverage under a federal law known as the Affordable Care Act. Residents of New York can learn more by visiting http://nystateofhealth.ny.gov

There is an open enrollment period for this type of health insurance. If you lose employer provided health insurance because, for example, you were not able to return to work due to disability, you should be able to secure health insurance coverage in a 60 day “special enrollment period” even if the general enrollment period is over.

However, be careful about accepting continued health insurance coverage from your employer under a federal law known as COBRA. If you accept continued health insurance (including when the employer pays the COBRA cost), you might not be able to get heath insurance under the Affordable Care Act when the COBRA payments end if it is not in an open enrollment period.

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