Applying for short-term disability in Wisconsin means different things to different people.
For some Cheese Heads, it means where do I file a claim for benefits to replace lost wages?
For other Badger State workers, it means where do I purchase a policy to protect income?
Wisconsin does not mandate coverage for accidents or illnesses that happen outside of work. Therefore, you must get a policy before you can file a claim.
If you did not purchase a policy, you will have limited options. However, because your income will be lower, you may qualify for benefits that help reduce expenses. Also, Social Security Disability Insurance and Workers’ Compensation could help.
Wisconsin Benefit Applications
You cannot apply for short-term disability benefits by filing a claim unless you enrolled in a policy before becoming sick, hurt, or pregnant. Wisconsin 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 to replace lost income. Fortunately, you may be eligible for other state-supported benefits based on your lower projected income.
Government grants become benefits to pay 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.
- Wisconsin Household Energy Assistance Program
- Wisconsin Water Assistance Program
- Temporary Assistance for Needy Families
- Section 8 Housing Vouchers
- Supplemental Nutrition Assistance Program (SNAP)
- BadgerCare (Wisconsin Medicaid for Adults)
State Insurance
Suppose you do not have a short-term disability policy. In that case, you can file a claim for benefits through SSDI, funded through FICA payroll taxes and mandated by the federal government.
However, the Wisconsin 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 in person or online. The Wisconsin Department of Health Services administers claims for state residents.
- 800-772-1213
- 800-325-0778 (TTY)
Private Insurance
Wisconsin 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.
WI New Policy Applications
Wisconsin does not mandate state short-term disability insurance covering non-occupational illnesses and injuries. Therefore, workers must get 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 Wisconsin employer offers short-term disability insurance as an employee benefit. You can still purchase coverage alone if your workplace does not provide an option.
Individuals can obtain short-term disability outside of their employers. 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 Wisconsin can sometimes purchase short-term disability insurance with lower premiums, more lenient underwriting, and more generous benefits.
Many independent contractors can get coverage with these superior terms. 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 Wisconsin offering a plan.
| Company | Primary City | Voluntary | Employer-Paid |
|---|---|---|---|
| Aptiv | La Crosse | X | |
| Fiserve | Brookfield | X | |
| Lakeside Curative Services | Racine | X | |
| Milwaukee Tool | Milwaukee | X | |
| Previa Health | Green Bay | X |
Government Agencies
Many government employees can get short-term disability insurance at work. An agency, department, or district might offer a voluntary or group short-term disability program or no program at all.
State & Local
State and local government employees can buy short-term disability insurance through a voluntary plan offered by the Wisconsin Retirement System.
The Income Continuation Insurance (ICI) program replaces a portion of your wages if you cannot work because of sickness or injury (both short and long-term). Wisconsin Statute § 40.62 authorizes the benefit.
Enroll by completing the Income Continuation Insurance Application (ET-2307) and returning it to your personnel office. File a claim by contacting the plan administrator, The Hartford.
- Toll Free: 1-800-960-0052
- Fax: 1-833-357-5153
Municipal
Some municipal government employees in Wisconsin can get short-term disability insurance through their city employer.
School
Many public school employees in Wisconsin, including female teachers seeking maternity leave benefits, can get short-term disability at work.
| School District | Voluntary | Employer-Paid |
|---|---|---|
| Baldwin-Woodville | X | |
| Deforest Area | X | |
| Madison Metropolitan | X | |
| Racine Unified | X | |
| Sturgeon Bay | X |
Federal
Many federal government employees work in Wisconsin 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 letter carriers are federal employees.
Universities & Colleges
Many university and college faculty in Wisconsin can get short-term disability insurance at their workplace.
| College | Voluntary | Employer-Paid |
|---|---|---|
| Alverno College | X | |
| Concordia University | X | |
| Marquette University | X | |
| Madison Area Technical College | X | |
| Wisconsin University System * | X |
* As a state-government entity, the university system offers the Income Continuation Insurance option at all campus locations: Eau Claire, Green Bay, La Crosse, Madison, Milwaukee, Oshkosh, Parkside, Platteville, River Falls, Stevens Point, Stout, Superior, and Whitewater.
WI Disability Requirements
The primary short-term disability requirement in Wisconsin 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 Wisconsin 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 medical 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. Wisconsin maternity leave laws provide for unpaid job-protected time off for parents, making this requirement crucial for new mothers.
If you delay the purchase until after conception, 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.
WI Premium Costs
Short-term disability insurance policies in Wisconsin offer unique feature combinations that policyholders can choose based on their impact on monthly premiums.
Our monthly 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, 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 IRS income-taxable 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.
WI Qualifying Conditions
Short-term disability insurance in Wisconsin 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, while 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 stress or anxiety, 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.”
WI Short-Term Disability Laws
Several Wisconsin laws affect workers dealing with a short-term disability (STD). None of these regulations provide income replacement, but they do address job security and other workplace concerns.
FMLA
The Family Medical Leave Act (FMLA) is a federal short-term disability law safeguarding Wisconsin 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.
WFMLA
The Wisconsin Family and Medical Leave Act (WFMLA) is a state-specific short-term disability law covering more workers while providing less time than its federal counterpart.
WFMLA provides unpaid time off for an employee’s serious health condition.
More Workers Qualify for WFMLA than FMLA
| FMLA | WFMLA | |
|---|---|---|
| Hours worked | 1,250 | 1,000 |
| Employer size | 50+ within 75 miles | 50+ employees |
FMLA Lasts Longer than WFMLA
| FMLA | WFMLA | |
|---|---|---|
| Employee disability | 12 weeks | 2 weeks |
| Childbirth | 12 weeks | 6 weeks |
Accommodations
Wisconsin state law prohibits discrimination against qualified individuals with disabilities who can perform essential job functions, with or without accommodation.
This rule may become crucial when an employee needs a reasonable accommodation to return to work after a brief absence for medical reasons.
The WI law defines a reasonable accommodation as a modification to a job, the work environment, or how things are done that allows individuals to complete their duties.
Unemployment
Wisconsin 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.
Wisconsin law provides an exception for workers who quit their jobs. You may be eligible to collect unemployment insurance if “your health left you with no reasonable alternative but to quit.”
WI Occupational Disability
In Wisconsin, 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
Wisconsin employees must not purchase temporary disability to file a claim application. By law, employers must furnish Worker’s Compensation Insurance for most personnel, with some exceptions.
- Domestic servants
- Some farm employees
- Volunteers
- Religious sect members
File a Worker’s Compensation claim following the responsibilities the Department of Workforce Development communicates.
- Tell your supervisor that you are hurt immediately
- Obtain any necessary medical attention
- Maintain all relevant medical and payment records
TDI Benefits
Wisconsin Workers’ Compensation includes temporary disability insurance and other benefits to speed your return to work and good health.
- Coverage of all reasonable and necessary medical expenses
- Benefits for temporary wage loss during the healing period
- 2/3 of pre-disability wages
- Subject to a maximum amount
- Benefits for permanent disability for partial recoveries
- Vocational rehabilitation and retraining
- Death benefits and burial expenses when necessary
