People in Pennsylvania ask how to apply for short-term disability for different reasons.
Some Pennamites may be interested in knowing where to purchase a policy to safeguard their income.
Others in the Commonwealth may wonder where to submit a claim to receive benefits that can replace their lost wages.
Pennsylvania has no state-mandated program covering off-the-job accidents or illnesses. To file a claim for benefits, you must have a policy beforehand.
However, since your income will be lower, you may be eligible for benefits to help you cut expenses. Additionally, you may be able to receive assistance from Social Security Disability Insurance or Workers’ Compensation.
Claim Filing Applications
You cannot apply for short-term disability benefits by filing a claim form unless you enrolled in a policy before becoming sick, hurt, or pregnant. Pennsylvania does not mandate a program covering off-the-job (non-occupational) accidents and illnesses.
State Benefits
If you do not have coverage, you cannot file a short-term disability claim form to replace lost income. Fortunately, you may be eligible for other commonwealth-supported benefits based on your lower projected income.
Government benefits help pay personal bills. Low-income families can present estimated future earnings on alternative benefit applications. These programs could keep your household afloat while recovering from an accident or sickness.
The Pennsylvania Department of Human Services administers assistance programs for many low-income families. For each resource, call 1-800-692-7462 or apply online.
- Your Pennsylvania Benefits provides an application point for several options.
- Supplemental Nutrition Assistance (SNAP)
- Temporary Assistance for Needy Families (TANF)
- Healthcare and Medical Assistance
- Guaranteed Income Pilot Projects
- Heating Assistance (LIHEAP)
- Home Water Help (LIHWAP)
- Legal Services
State Insurance
Suppose you do not have a short-term disability policy. In that case, you can file a claim through Social Security Disability Insurance (SSDI). You funded SSDI premiums through FICA payroll taxes mandated by the federal government.
However, the Pennsylvania state-administered benefits are lacking and difficult to get.
- SSDI covers disabilities lasting twelve months or longer. You become ineligible by returning to work before then.
- They use a strict Any-Occupation definition. You are ineligible if you can perform any substantial gainful activity.
- You must wait five months before benefits begin. Many live check-to-check while working and have no savings.
- Most families experience a massive pay cut because the average monthly SSDI benefit is only $1,400.
Apply for SSDI benefits online at SSA.gov. For those who are deaf or hard of hearing, contact the Social Security Administration at TTY 1-800-325-0778.
The Bureau of Disability Determination (BDD) in the PA Department of Labor & Industry assists the Social Security Administration (SSA) in determining eligibility for SSDI benefits. Contact BDD at 1-888-772-1409 if you have any of these issues.
- The local field office informs you that your claim is pending
- You received a call or letter requesting medical information
- You appealed and received a call or letter about a hearing
You can also schedule an appointment at a local SSA field office.
| Social Security Offices | Phone Number |
|---|---|
| 807 Crosby Street Chester, PA 19013 | (866) 398-1456 |
| Suite 120 650 Washington Road Pittsburgh, PA 15228 | (888) 717-1525 |
| Suite 117, the Marketplace at Steamtown 300 Lackawanna Ave Scranton, PA 18503 | (570) 343-3400 |
| 41 N 4th St Allentown, PA 18102 | (877) 405-6746 |
| Suite 200 201 Penn St Reading, PA 19601 | (866) 274-5960 |
Private Insurance
Pennsylvania workers who purchased a short-term disability policy before getting sick, hurt, or pregnant can apply for benefits. File a claim with the private insurance company that issued your policy.
Find the phone number and website URL in your files. Download the claim form and follow the instructions carefully to avoid unnecessary delays.
Complete the document and submit it for underwriting review. If approved, the insurer will begin sending checks per the terms outlined in your policy.
New Policy Applications
Pennsylvania does not mandate state short-term disability insurance covering non-occupational illnesses and injuries. Therefore, workers must buy coverage before getting sick, hurt, or pregnant. There are three avenues, ordered by preference.
| Good | Better | Best | |
| Plan Type | Individual (outside of employers) | Voluntary (employee-paid) | Group (employer-paid) |
| New Policy Application | Must complete | Must complete | Automatic enrollment |
| Monthly Premiums | Highest | Lower | Lowest ($0) |
| Underwriting | Strict: more policy denials | Lenient: fewer policy denials | Guaranteed issue: no policy denials |
Individual Plans
Not every Pennsylvania employer offers short-term disability insurance as an employee benefit. You can still purchase coverage alone if your workplace does not provide an option.
You can buy a new policy as an individual without going through your employer. Request a quote online to find a licensed agent to take your application. However, these plans have several drawbacks.
- Premiums will be higher
- Underwriting criteria are stricter
- Benefits are less generous
Self-Employed
Self-employed business owners in Pennsylvania can sometimes purchase short-term disability insurance with lower premiums, more lenient underwriting, and more generous benefits.
The self-employed can get coverage with these superior terms if they work as independent contractors. Several insurance companies will issue worksite plans to 1099 employees, provided the premiums are payroll-deducted.
Private Employers
Many private employers offer short-term disability insurance as an employee benefit. Below are several large companies in Pennsylvania offering a plan.
| Company | Primary City | Voluntary | Employer-Paid |
| Aramark | Philadelphia | X | |
| Comcast | Philadelphia | X | |
| UPMC | Pittsburgh | X | |
| Ricoh USA | Exton | X | |
| Communications Construction Group | Westchester | X |
Government Agencies
Many government employees in Pennsylvania can get short-term disability insurance at work. An agency, department, or university might offer a voluntary or group (employer-paid) program.
Commonwealth
State government workers can buy short-term disability insurance through a voluntary plan offered by the Prudential Insurance Company.
The employee-paid program allows you to receive 60% of pre-disability income or up to $1,000 weekly, whichever is less. Rates vary by age and salary.
- Enroll online at the employee resource center or by calling Prudential at 800.893.7316.
- File a claim for benefits after an off-the-job accident or illness by logging into the online customer portal hosted by Prudential.
Municipal
Some municipal government employees can get short-term disability insurance through their city employer.
| Municipal Area | Voluntary | Employer-Paid | Neither |
| Philadelphia | X | ||
| Pittsburgh | X | ||
| Allentown | X | ||
| Eerie | X | ||
| Scranton | X |
School
Many public school employees in Pennsylvania, including female teachers seeking maternity leave benefits, can get short-term disability at work.
.
| School District | Voluntary | Employer-Paid | Neither |
| Philadelphia | X | ||
| Pittsburgh | X | ||
| Reading | X | ||
| Central Bucks | X | ||
| Allentown | X |
Federal
Many federal government employees work in Pennsylvania at the Departments of Agriculture, Veterans Affairs, Homeland Security, Justice, Interior, Treasury, Transportation, and many more.
Federal employees can enroll in a voluntary short-term disability plan by contacting a licensed insurance agent outside their agency and arranging to pay the premiums through payroll allotment.
Postal workers are federal employees.
Universities & Colleges
Many Pennsylvania university and college faculty and staff can get short-term disability insurance at their workplace.
Public Universities
| Public University | Voluntary | Employer-Paid | Neither |
| University of Pittsburgh | X | ||
| Penn State University | X | ||
| Temple University | X | ||
| Slippery Rock | X |
Private Colleges
| Private College | Voluntary | Employer-Paid | Neither |
| University of Pennsylvania | X | ||
| Albright College | X | ||
| Allegheny College | X | ||
| Bryn Mawr | X | ||
| Carnegie Mellon | X |
Pennsylvania Requirements
The primary short-term disability requirement in Pennsylvania is buying an insurance policy before getting sick, hurt, or pregnant to protect your income. No state law forces enrollment for programs covering off-the-job (non-occupational) accidents or illnesses.
Pre-Existing Condition
Buy short-term disability in Pennsylvania before you have a pre-existing health condition. The pre-existing condition requirement might affect your coverage when purchasing a policy and filing a benefits claim.
If you have a pre-existing condition, short-term disability coverage begins twelve months after the policy’s effective date. However, many people with pre-existing health conditions are ineligible for coverage.
You must be healthy enough to get the coverage. When completing the new policy application, expect the insurance agent to ask detailed questions about your medical history.
Maternity Leave
Women must purchase short-term disability for pregnancy before conception. Pennsylvania maternity leave laws provide for unpaid job-protected time off for parents, making this requirement crucial for new mothers.
If you purchase coverage when already pregnant, two policy exclusions will eliminate maternity leave benefits associated with your current baby.
- The policy will exclude pregnancy-related disabilities during the first twelve months after the effective date as a pre-existing condition.
- The policy will not pay benefits for any losses caused by your giving birth due to normal pregnancy within nine months after the effective date.
PA Premium Costs
Short-term disability insurance policies in Pennsylvania offer unique feature combinations that policyholders can choose based on their impact on monthly premiums.
Our monthly premium cost calculator illustrates how the benefit period, monthly amount, and elimination period affect monthly premiums. Meanwhile, factors that remain constant may also impact rates.
- Tobacco use
- Job role
- Industry classification
- Age
Benefit Period
Short-term disability benefits last the lesser of your recovery time (when a doctor clears your return to work) or the benefit period stated in the policy.
Employees choose the benefit period when buying the coverage. The longer the policy pays claims, the higher the monthly premium costs.
| Monthly Premiums | Benefit Period |
| Lowest | 3 Months |
| Middle | 6 Months |
| Highest | 24 Months |
Monthly Amount
The maximum that short-term disability pays is two-thirds of income or a monthly limit (typically $7,500), whichever is lower.
Employees choose the monthly amount when enrolling in the coverage. Higher monthly amounts result in costlier monthly premiums.
| Monthly Premiums | Monthly Amount |
| Lowest | $1,000 |
| Middle | $3,000 |
| Highest | $7,500 |
Elimination Period
Short-term disability benefits start after satisfying the policy’s elimination period, which means the time when claims are not payable.
Employees choose the elimination period when purchasing the coverage. The more quickly benefits begin, the higher the monthly premium costs.
| Monthly Premiums | Elimination Period (Days) |
| Lowest | 90 accident/90 sickness |
| Middle | 30 accident/30 sickness |
| Highest | 0 accident/ 7 sickness |
Tax Consequences
Short-term disability has income tax implications because it insures wages. Your choice of payment method impacts the upfront monthly cost or the downstream claim payment.
- The benefits are income-taxable when filing a claim if you pay the premiums with pre-tax payroll deductions. In this case, you save money upfront.
- The benefits are tax-free when filing a claim if you pay the premiums with after-tax dollars. In this instance, you save money when you need it most.
PA Qualifying Conditions
Short-term disability insurance in Pennsylvania covers injuries and illnesses that satisfy your insurance policy’s definition of a qualifying medical condition causing lost income. The policyholder must be under the regular care of a licensed physician.
Qualifying Accidents
Qualifying accidental injuries for short-term disability must meet specific criteria. Check your policy for statements like these.
- Occurs after the effective date and while the policy is in force
- Is of a type listed in the policy schedule
- Is not excluded by name or description
- While committing a crime
- While driving in a race
- Practicing or playing a professional sport
- Injuring yourself intentionally
- Flying in an unscheduled airplane
- Being exposed to an act of war
Qualifying Illnesses
Qualifying sicknesses for short-term disability must meet similar standards. Check your policy for statements like these.
- Is diagnosed after the policy effective date
- Is of a type listed in the policy schedule
- Causes a loss beginning while the policy is in force
- Is not excluded by name or description
- Addiction to drugs or alcohol
- Having a mental or emotional disease
- Having a pre-existing health condition
Surgery
Surgery often qualifies for short-term disability benefits, provided the operation meets the criteria for illnesses and accidents noted above.
Claim payments work differently for surgery based on the type of operation and your recovery time.
- The surgery must be medically necessary. Cosmetic procedures reshaping healthy tissue to improve appearance do not qualify.
- The recovery time must exceed the elimination period. Wisdom tooth removal would not meet the threshold, but a hysterectomy or knee replacement might.
Mental Health
Mental health problems rarely qualify for short-term disability. Mood or thought disorders are not medical conditions.
To receive benefits for mental health issues, a policyholder must have group coverage rather than an individual policy. Employer-paid plans sometimes include these benefits, while employee-paid programs typically do not.
An employee-paid individual policy might have an exclusion similar to the statement, “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.”
Own Occupation
A loss of income from your regular occupation is often a qualifying condition for short-term disability. Many policies contain an Own-Occupation definition, which is more lenient than an Any-Occupation standard.
Read your insurance policy and look for the definition of disability. An Own-Occupation standard might read as follows; “Totally disabled means you cannot perform all of the material and substantial duties of your regular occupation.”
PA Short-Term Disability Laws
Several Pennsylvania laws affect workers dealing with a short-term disability (STD). None of these regulations require income replacement for non-occupational losses. Still, they do address job security and other workplace concerns.
FMLA
The Family Medical Leave Act (FMLA) is a federal short-term disability law safeguarding Pennsylvania workers. FMLA provides twelve weeks of unpaid job-protected time off for eligible employees working for a covered employer.
You can use FMLA and STD together for your serious medical condition. However, you would be ineligible to take both concurrently to care for a sick family member.
Border Commuters
The most frequently exercised short-term disability law in Pennsylvania applies to commuters crossing state borders in both directions. Two neighboring states have legal mandates based on where you work rather than where you reside.
- New Jersey has a required program. NJ residents who commute to work in Chester, Philadelphia, Levittown, Bethlehem, Easton, or Stroudsburg lose their income replacement – conversely, PA residents who commute to work in NJ gain short-term disability benefits.
- New York has a mandatory program. NY residents who commute to work in Scranton, Sayre, Bradford, or Erie lose their income replacement benefits – meanwhile, PA residents who commute to work in NY gain short-term disability coverage.
However, mandatory state programs do not cover commuters to and from Delaware, Maryland, West Virginia, and Ohio.
Unemployment
Pennsylvania law does not permit workers to collect unemployment while on short-term disability. The two programs have mutually exclusive criteria.
You cannot file for unemployment if you are off for medical reasons because you fail the primary test: being physically able to work. However, you might be eligible after your recovery.
Pennsylvania law provides an exception for workers who quit their jobs due to health reasons. You must have informed your employer of any limitations before resigning. The claimant may be eligible if the employer fails to offer suitable work.
PA Occupational Disabilities
In Pennsylvania, Workers’ Compensation provides temporary disability insurance covering on-the-job (occupational) accidents and illnesses. State law mandates the coverage, meaning employees do not need to enroll proactively.
TDI Applications
Pennsylvania employees must not purchase temporary disability to file a claim. By law, employers must furnish workers’ compensation insurance for most personnel, with some exceptions.
| Covered by Other Programs | Exempt from Requirements |
|---|---|
| Federal civilian employees | Volunteers |
| Railroad workers | Agricultural laborers |
| Longshoremen | Domestic employees |
| Shipyard and harbor workers | Granted religious exemptions |
Report any injury or work-related illness to your employer or supervisor immediately to file a Worker’s Compensation claim. Suppose the Worker’s Compensation claim is denied. In that case, employees have the right to file a petition for a hearing before a judge.
If your employer does not have insurance, you may be eligible for Uninsured Employer Guarantee Fund benefits. Contact the PA Bureau of Workers’ Compensation by phone.
- 800-482-2383
- 717-772-4447
TDI Benefits
Pennsylvania Workers’ Compensation provides benefits, including temporary disability insurance, to help you replace lost income and recover your health more quickly.
- Payments for lost wages
- If totally disabled and unable to work
- If partially disabled and earning less than pre-disability wages
- Death benefits to surviving dependents
- Specific loss benefits
- Lost permanent use of appendages
- Lost hearing or eyesight
- Disfigurement of head, face, or neck
- Medical care
- Reasonable surgical and medical services
- Rendered by a licensed physician or healthcare provider
