What Is Temporary Disability Insurance?
TDI is offered through a government program in five states and Puerto Rico. It’s designed to complement worker’s compensation. Temporary disability insurance (TDI) pays benefits when an employee can’t work due to a non-work-related illness or injury. TDI is different from workers’ compensation, which covers injuries that happen while an employee is on the job.
Benefits
If you can’t work due to an illness or injury, temporary disability insurance can help replace your income and pay for your living expenses while you recover. Many employers provide this coverage as part of their benefits package, or employees can purchase it individually.
If a work-related injury or illness keeps you out of work for longer than your short-term disability policy will cover, a long-term disability plan can help. A long-term disability plan works with a short-term disability policy to pay an employee’s wages until they can return to work.
Often, short-term disability policies are designed to last only a few months, so you’ll want to buy additional long-term coverage to extend the time you’re out of work. The length of time you’ll receive coverage depends on the nature of your illness or injury and the expected recovery periods. The amount of money paid out can also depend on your insurance’s specific terms and conditions.
Claims process
Temporary disability insurance (TDI) is a program that provides cash payments to workers who are disabled and unable to work for an extended period. The amount paid is usually one-half of the worker’s average weekly wage, up to a maximum payment of $170 per week.
To begin a TDI claim, you should file Form DB-450, Notice and Proof of Claim for Disability Benefits. You may get this form from your employer, insurer, or the New York State Special Fund for Disability Benefits.
The TDI claims process takes 30-45 days, but it can be longer if the insurance company needs more information from you or your doctor. If you provide this information as soon as asked, the claims process will move faster.
If there is a dispute over what your medical treatment or doctor reports, you and the claims administrator might hire a qualified medical evaluator (QME) or an agreed medical evaluator (AME). These are doctors who are experienced in the evaluation of workers’ compensation claims.
Limits
Temporary disability insurance is a great way to protect your income if you are forced to miss work due to illness or injury. It can help you cover expenses such as mortgage payments or groceries while recovering from your disability.
The limit on your coverage may vary, but most temporary disability policies pay out a percentage of your weekly salary, typically up to 60 percent. They also usually last between nine to 52 weeks.
Long-term disability insurance, however, requires full underwriting before you can qualify for benefits. If you need to buy a policy, your best bet is an individual disability plan, which offers excellent financial protection and will replace more of your income.
Exclusions
If you’re considering applying for temporary disability insurance, you should know that policies come with exclusions. Your policy will only cover these events or body parts if you meet specific criteria.
Some standard exclusions include pre-existing conditions, travel, and mental and nervous disabilities. You can find these in both group and private disability insurance policies.
A pre-existing condition is a health problem you had within a set period before your coverage began. This period varies from contract to contract, but it must be documented and treated before your insurance company will consider you eligible for benefits.
Other standard exclusions in long-term disability insurance policies include movement-based disabilities, which disqualify you if you have a medical condition that causes erratic movements. However, the exclusion does not apply to you if you have other disabling conditions, such as a musculoskeletal issue or a psychological disorder. If you believe your LTD insurer has used an ambiguous exclusion to deny your claim, contact an experienced attorney immediately.