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Short Term Disability California

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  • Short Term Disability California

    I am out on STD but my surgeon doesn't send all my medical records to the insurance co. It's a big hospital so I have to go through a different department. Now they're saying its not an approved leave (my work). The deadline has been reached from my Insurance co. My insurance co is saying it was approved for the first 3 months then it hasn't been approved and now they closed it and I'm not even eligible for LTD. I got a call from my employer and they said I was laid off and that once they receive a letter from my doctor releasing me they will take me off payroll and send a compensation package. As all this is happening, I got hired for a new job. I start the next day after I see my doctor which I know he'll be releasing me to go back to work. This in CA. What am I exposing myself too? Am I doing anything wrong and can they find out I have another job? If I wasn't approved by my insurance co and then it trickles down to my job not accepting my leave and its an unauthorized leave, is it still considered a layoff?

  • #2
    You have a lot of different issues and you are trying to overlap them. STD is not leave. It is simply income replacement while you are on leave. It is approved by the carrier not your employer. Qualifying is between you and the varroer and up to the rules of the plan. Typically you must submit regular medical documentation to substantiate your inability to work for medical reasons. If you are working, capable of working, or fail to meet the criteria for disability as defined by the policy, you are not eligible. Any appeals process would also be through that company. STD is typically 3 months, but it depends on the terms of the plan. LTD is a separate plan with separate qualification criteria and you would need to apply to that separately. If you are returning to work, you aren't going to be eligible.

    The longest your employer must hold your job, if you qualify, is 12 weeks. This leave must be applied for with your employer and is totally separate from getting benefits under STD. You don't say why you were laid off or when, but being off work is not an automatic bar to being let go.

    There is nothing to prevent you from accepting a new job absent a contract with your previous employer.
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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    • #3
      Originally posted by ElleMD View Post
      You have a lot of different issues and you are trying to overlap them. STD is not leave. It is simply income replacement while you are on leave. It is approved by the carrier not your employer. Qualifying is between you and the varroer and up to the rules of the plan. Typically you must submit regular medical documentation to substantiate your inability to work for medical reasons. If you are working, capable of working, or fail to meet the criteria for disability as defined by the policy, you are not eligible. Any appeals process would also be through that company. STD is typically 3 months, but it depends on the terms of the plan. LTD is a separate plan with separate qualification criteria and you would need to apply to that separately. If you are returning to work, you aren't going to be eligible.

      The longest your employer must hold your job, if you qualify, is 12 weeks. This leave must be applied for with your employer and is totally separate from getting benefits under STD. You don't say why you were laid off or when, but being off work is not an automatic bar to being let go.

      There is nothing to prevent you from accepting a new job absent a contract with your previous employer.
      I was laid off due to downsizing but they told me I will be on the payroll until my doctor clears me to return to work. Thats when my compensation package kicks in. While laying down I got a job through a friend who I've worked with. The doctor has not yet cleared me for my previous job, but I start my job a couple days before he faxes over the note to go back to work. Pretty much everything overlaps for a couple weeks. Will my previous employer find out? My state disability ends just about the same time, which is the best thing since I dont have to call and cancel. I just want to make sure that I wont have issues with my previous employer and the insurance co that they go through which are reviewing my medical files as we speak to approve the leave for the past 3 months. The first 3 months were approved by insurance co.

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      • #4
        You can be downsized even if you are on leave. I have no idea why they would leave you on the books until you are cleared by the doctor but nothing prevents them from doing so.

        If you start the new job, or your doctor clears you to resume working, you are no longer eligible for any STD plan. Not through the state, not through whatever private insurance you might have. Collecting whole working another job or after the doctor has cleared you is insurance fraud and carries some steep penalities. You don't want to play on odds on not being found out. BAD idea. If you are cleared or resume working, contact the STD providers and let them know your situation changed.
        I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

        Comment


        • #5
          Originally posted by ElleMD View Post
          You can be downsized even if you are on leave. I have no idea why they would leave you on the books until you are cleared by the doctor but nothing prevents them from doing so.

          If you start the new job, or your doctor clears you to resume working, you are no longer eligible for any STD plan. Not through the state, not through whatever private insurance you might have. Collecting whole working another job or after the doctor has cleared you is insurance fraud and carries some steep penalities. You don't want to play on odds on not being found out. BAD idea. If you are cleared or resume working, contact the STD providers and let them know your situation changed.
          Thanks for the response. The reason why I say they will let me go when I send a doctors note is because they were trying to be nice. Now is it bad that my doc can't send me a letter right away and that it overlaps a couple of days? Pretty much, can I work while I'm still technically on payroll with previous co and have been informed I'm going to be laid off once I send in my clearance note? i already started working a couple days before I send the note. Now, what happens if my insurance co denies the last 3 months of my disability? Will my work state I had left with no excuse and fire me instead? I hope this makes sense.

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          • #6
            Why not just be honest with your previous employer and state you found another job and started on M/D/Y? Why play games and hope they don't notice or find out you are really working?

            As for the disability coverage you need to let them know you are working STAT. I am not sure why you think they will demand you repay the last 3 months of benefits. That doesn't make sense unless you really weren't disabled. They will cut off benefits once you were eityher cleared or started working. If you have been overpaid because you failed to disclose this, you will owe back the overpayment.
            I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

            Comment


            • #7
              There seems to be a persistent rumor about the Internet that if you don't return to work, you will have to repay your disability benefits. I don't know where that comes from.

              For the record, I have worked in Benefits since 1979. I have seen literally hundreds of short term disability policies from all manner of providers. I post on two different HR boards where HR professionals share information about their policies and benefits. In all that time, I have never ONCE seen or heard of a policy where you have to repay disability benefits if you don't return to work. NEVER.

              IF you are on FMLA AND IF you do not return to work by your own choice, your employer CAN (because he can does not mean he will) ask you to repay him for health insurance premiums that may have been paid on your behalf. NOTHING about repaying disability. NOTHING about repaying benefits.
              The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

              Comment


              • #8
                As Elle said though if you were working during part of those 3 months or cleared for work or not disabled, then you would need to pay back benefits for the time you were working/cleared for work/not disabled.
                Last edited by Betty3; 01-08-2013, 03:52 PM.
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