If you’re unable to work because of an illness or injury, you may be wondering: “Can I get short term disability through my spouse’s insurance?” It’s a common question, especially when families rely on one spouse’s workplace benefits to cover extended health costs like prescriptions, dental, or vision. However, short term disability (STD) benefits don’t work the same way as other health benefits. STD is an income replacement benefit, designed to cover the employee who is directly insured through their own employer’s plan. This blog will explain what short term disability is, whether you can claim through a spouse’s insurance, and what to do if your STD claim has been denied.
What is short term disability (STD)
If a medical condition is stopping you from doing your job, you may want to consider applying for Short Term Disability (“STD”) benefits. STD coverage is available through your own employer’s insurance benefits plan. STD benefits are for a finite period, often providing income replacement for a few months. Look at your STD benefits booklet to determine how much STD coverage is available and how much you are covered for.
How to Start an STD Claim?
To begin an STD claim, you’ll need to submit two forms:
- A Plan Member Statement (PMS) – the PMS provides your employment background information along with some particulars of your medical diagnoses.
- An Attending Physician Statement (APS) – the APS is completed by your main treating practitioner (often your family physician) and describes your condition, medical restrictions/limitations and your anticipated return to work date (or reassessment date).
Your employer submits a third form called a Plan Sponsor Statement. Once all three forms have been submitted, the insurance company will make a decision on your claim.
Can I Claim STD Through My Spouse’s Insurance?
A common question is: “Can I get short term disability through my spouse’s insurance?” Unfortunately, the answer is no. STD benefits only apply to the employee who is directly covered under their own employer’s insurance plan.
Although the remainder of the extended health benefits plan will likely provide coverage (dental, vision, prescription medication) to one’s spouse, STD benefits will not extend.
The STD benefit is intended to cover the individual who is working for the employer because it is an income replacement benefit. A person’s spouse is not provided with short term disability coverage because they are not receiving income from the employer. From a practical standpoint, it would not make sense to extend STD coverage to one’s spouse.
What to Do If Your STD Claim Has Been Denied?
If your short-term disability claim is denied, you have a few options. The STD insurer will provide you with an option to appeal the denial. If you wish to pursue an appeal, you’ll need to provide new medical information to your case manager to try and overturn the denial. Appeals are not always recommended as new medical information is reviewed by the same case manager who denied your claim originally.
The other (and better) option is to hire a lawyer to challenge the denial of benefits. Having an experienced disability lawyer in your corner can help you get the benefits you deserve.
If you have made an STD claim and your benefits have been wrongfully denied, contact the disability lawyers at Whitten & Lublin. Our experienced disability lawyers can help you take control of your rights and challenge your STD denial. Contact us online or call us 416 640 2667.
Author – Aman Chaggar
