Having a major surgical procedure is stressful. And it becomes even more stressful when the need for surgery also leads to financial hardship. In that vein, we recently got a question from a reader asking: “I just had joint replacement surgery. Can I receive temporary disability benefits?”
This reader is not alone. Many individuals facing a surgical procedure wonder if they can get some sort of temporary disability support. That’s understandable because the last thing anyone wants to worry about while recovering from major surgery is paying the bills.
While the Social Security Administration offers disability programs, these are for people with long-term disabilities. Theoretically you might be able to apply for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) after surgery. But your recovery will have to last more than a year before you get benefits. Generally, the SSA will deny most surgical claims for disability since patients usually heal before they even qualify.
So what other options are there? Read on to learn how a person might qualify for temporary disability assistance when facing the prospect of major surgery.
Option #1: You Work Somewhere That Has State-Sponsored Temporary Disability
There are currently eight states with state-sponsored temporary disability insurance (TDI) or short-term disability insurance (SDI) programs. These states provide benefits either through mandatory employee/employer contributions to a state fund, or by requiring employers to carry insurance.
Keep in mind that TDI/SDI programs are not for illnesses or injuries that happen at work. Those fall under the classification of workers’ compensation.
If you work in one of the following states, you have access to temporary disability through a TDI/SDI program:
The requirements, duration, and compensation amounts vary widely within each program. Generally, these benefits last as little as 12 weeks, though some go up to a year. However, state-sponsored programs are worth exploring if you need time off for surgery.
Keep in mind, though, that a major surgery usually only qualifies for temporary disability benefits if it’s medically necessary. In other words, this surgery must happen to prevent, diagnose, or treat an illness, injury, disease, or symptoms.
Returning to our reader’s question, an individual who had joint replacement could potentially get these temporary disability benefits while recovering. Though it’s technically elective surgery — meaning scheduled in advance, not emergency — a joint replacement usually meets the medical necessity requirement.
Option #2: Your Employer Offers Short-Term Disability Benefits
If you don’t work where there’s a state-sponsored program — or even if you do — check with your employer. You may have temporary disability insurance as an employee benefit if you’re still working.
Refer to your employee handbook or reach out to your Human Resources department directly to see if temporary disability insurance is part of your benefits package. Also find out if participation is automatic, or if not, how they determine eligibility.
Most programs stipulate that employees must work for the company for a certain amount of time before receiving TDI/SDI benefits. This is especially true in the case of pre-existing conditions. It’s also not uncommon for employees to have to exhaust all their sick days before coverage kicks in. If you need to have a major surgery, it’s important to ask your employer about these specifics.
Typically, employer-sponsored temporary disability plans will once again offer benefits for surgery only when it is medically necessary. That means a cosmetic surgery purely for physical enhancement will not qualify. However, plastic surgery to repair a deformity or reconstruction from an illness may fall under the category of medical necessity.
Generally, employees must provide medical documentation from their doctor detailing the diagnosis and surgical recommendation. They will also have to prove that they are out of work post-surgery per doctor’s orders. And the duration of their coverage depends upon when and if they can do their job again.
That said, most employer temporary disability insurance policies still have a time limit. In other words, payments will cease once you reach that date, regardless of your condition.
Option #3: You Purchased a Private Temporary Disability Insurance Policy Prior to Surgery
Another way to get temporary disability is to purchase your own supplemental insurance policy prior to surgery.
Carrying this kind of personal insurance is a smart move to protect your wages from non-occupational work absences. That’s because you can’t assume the government or an employer will automatically step in to help you with temporary disability. Or that it will be enough if they do.
For example, the state-sponsored temporary disability program in New York pays a maximum of $170/week. That’s tough to live on. But you don’t want to postpone any necessary medical procedures for fear of not being able to pay your bills. In this case, also having a personal temporary disability policy would really help.
The caveat is you will probably have to enroll well before you find out you need surgery. That’s because an insurer will require you to take a medical exam or answer a health questionnaire before offering coverage. An insurance provider may decline to offer a new policy if your doctor has already recommended surgery. And most policies exclude benefits for any operations that involve pre-existing conditions within 12 months of the effective date.
However, if you already have a supplemental policy and now need surgery, this is the time to file a claim! Call your insurance provider and submit your medical documentation. Upon approval, you could start receiving these benefit payments in as little as eight days.
You May Qualify for Legal Assistance
Finally, if you think you qualify for temporary disability but are running into roadblocks, consider consulting with a disability lawyer. It can be very confusing figuring out where to file and what you need to be successful with a claim. A skilled disability attorney can help you navigate your options, so you can focus on what’s most important after surgery. Healing.
Ready to see if you may qualify? Click the button below to start your free online benefits evaluation now:
Kimberly Dawn Neumann
Kimberly Dawn Neumann is a multi-published NYC-based magazine and book writer whose work has appeared in a wide variety of publications ranging from Forbes to Cosmopolitan. She graduated summa cum laude from the University of Maryland, College of Journalism. For more, visit: www.KDNeumann.com, Instagram @dancerscribe, and Twitter @KimberlyNeumann