Does Short-Term Disability Cover Mental Health or Rehab?

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Mental Health word cloud

Some questions have no single correct answer. The only way to know is to reference the summary plan description or file a claim with objective medical evidence.  

Short-term disability is more likely to cover specific mental health conditions than others. For instance, all plan types might support organic senile dementia, while individual and personal policies often exclude anxiety, depression, and other psychoses.

Short-term disability is more likely to cover specific stays in a rehabilitation clinic than others. For instance, all plan types might support prescription narcotics addictions, while personal and individual policies might exclude addictions to alcohol or illegal drugs.

Anxiety & Depression

For two reasons, your ability to get short-term disability benefits for anxiety and depression may prove more challenging than other mental health conditions.

  1. The fewer people paying into a program, the less likely it is to support claims
  2. The most severe mental illnesses cause longer-lasting work disruptions
Table Of Contents
  1. Anxiety & Depression
  2. Addiction Rehabilitation

Denials

The insurance company will deny claims for anxiety and depression when policies cover fewer lives. For example, individual policies sold outside employers and voluntary personal programs funded through payroll deduction at work fit into this category.

Expect a claim denial when the summary plan description includes legal language similar to this excerpt.

“We will not pay benefits for losses that are caused by or are the result of your having a mental or emotional disease or disorder of any kind, including psychosis and mood disorders.”

  • Anxiety and clinical depression fit squarely into the mood disorder category, including grief, postpartum depression, panic attacks, and post-traumatic stress disorder (PTSD).
  • Other mental illnesses fall under the same umbrella, including bipolar disorder, schizophrenia, and eating disorders such as anorexia or bulimia, and more.
  • Alzheimer’s Disease and other organic senile dementias might be the only illnesses covered under the policy.

Approvals

How do you get short-term disability approved for anxiety and depression? First, the large group program must support this mental health condition. Also, you may have to show that the illness will prevent you from working for at least twelve consecutive months.

State Programs

It is easiest to get state-mandated short-term disability approved for anxiety and depression because the local government forces all workers to contribute towards premiums. The hundreds of thousands of people paying into the system make comprehensive benefits more feasible.

For example, California defines a disability as “an illness or injury, either physical or mental, which prevents you from performing your regular and customary work.”

Hawaii, Massachusetts, New Jersey, New York, Rhode Island, and Washington are other states with required programs that could follow a similar definition.

Social Security

You could get short-term disability benefits through Social Security approved for anxiety and depression. The federal government forces hundreds of millions of workers to fund the system via FICA taxes, enabling the broader benefits.

A successful claim demonstrates that the mental health condition fits the disability definition: the illness will prevent you from performing any work for at least twelve months. Pay no attention to people telling you that Social Security does not support temporary losses without first defining the parameters.

The amount Social Security disability pays for anxiety, depression, and other mental illnesses depends on your work history rather than your diagnosis: the amount earned every year and the number of years paying into the system.

Addiction Rehabilitation

The answer to whether short-term disability covers rehabilitation for alcoholism or drug addictions has three elements for this set of mental health conditions.

  1. The fewer people paying into a program, the less likely it is to support claims
  2. The average one-month stay in a recovery center rules out several options
  3. People weaning themselves from prescription opioids have more benefits

Drug Rehab

Short-term disability is most likely to cover drug rehab when the covered person is addicted to a prescription pain medication rather than an illegal substance used for recreation.

Individual Policies

Short-term disability qualifying conditions include recovering from physical injuries and illnesses under a doctor’s care. Therefore, individual and personal policies might not exclude specific addictions.

For example, your summary plan description might have a similar statement.

“We will not pay benefits for losses that are caused by or are the result of addiction to alcohol or drugs, except for narcotics taken as prescribed by your doctor.”

Government Policies

The government-sponsored short-term disability programs are more likely to cover drug rehab stays because they can pool premium dollars from an enormous number of people.

Below are three examples.

  1. Social Security covers drug addiction and alcoholism if they would still find you disabled if you stopped using drugs or alcohol.
  2. California SDI pays benefits for 45 days for people living at an approved drug-free residential rehabilitation facility, plus an additional 45 days if warranted.
  3. New Jersey TDI supports claims for drug addiction as they are no longer using illegal drugs and they are being treated for their substance abuse.

Alcohol Rehab

Short-term disability is least likely to cover alcohol rehab because of the relatively brief stays while recovering from alcoholism and the belief in many circles that the condition is self-inflicted.

  • Social Security disability would exclude coverage for alcohol rehab because the detox process ends long before meeting the primary qualification: twelve consecutive months.
  • Individual and personal policies might exclude addiction to alcohol because a physician would never prescribe beer, wine, or liquor to relieve pain connected with a medical procedure such as surgery.

Meanwhile, state temporary disability programs are more likely to cover alcohol rehab because they fit the three criteria: large groups, address brief stays and sometimes include liberal definitions.