Short-Term Disability is based on an illness or injury and symptoms that result in an individual being unable to work. We do not pay Short-Term Disability benefits for requests due to asymptomatic quarantine, reluctance in returning to work, or a positive test alone. However, there may be situations where an absence or statutory disability claim is supported.
Our Short-Term Disability Case Managers have received specialized COVID-19 training. Additionally, we have a small team consisting of our top technical experts ready to review claims, help to answer questions and ensure benefit decisions are made timely. Our Short-Term Disability team works closely with Sun Life’s Medical Director as well as trained Clinicians to deliver the highest quality of service and claim management.
We have also streamlined guidelines to assist with evaluating COVID-19 disability claims:
Positive COVID-19 Test
If a plan member has tested positive for COVID-19, is experiencing symptoms, and cannot perform the duties of their occupation, we will review the member's claim for Short-Term Disability benefits. Benefits will begin after the member meets the eligibility requirements, elimination period, and applicable contractual provisions. Benefits may be offset by other sources of income. If the employee remains disabled after that time, we will work with them to obtain required medical documentation.
Plan members and plan sponsors still need to complete a Short-Term Disability claim statement as part of the application process. This allows us to validate important information such as health status, last day worked, salary information, and also confirm coverage.
Our Claims and Medical Teams will assist in gathering the information needed. We realize that, given current conditions, employers and healthcare providers are operating and communicating in non-traditional ways.
No Positive COVID-19 Test Result and Displays Symptoms
If a plan member has a flu-like illness but has not been tested or does not have a positive test result for COVID-19:
We will continue to adjudicate each claim based on the definition of total disability and,
We will apply the elimination period
We will not pay Short-Term Disability benefits to a plan member who only tests positive for COVID-19, is not ill, and otherwise does not meet the applicable policy’s definition of disability. This applies whether they self-isolate:
- At the direction of their employer, or
- Following any government or public health directive that recommends employees stay home as a precaution to prevent the spread of COVID-19.
For clarity, if plan members do not have signs of an illness but are placed under quarantine by a doctor or public health official, they will not be eligible for Short-Term Disability benefits.
Employees may qualify for other benefits including, but not limited to, unemployment compensation, and other federal, state, or local statutory benefits or other absence-related benefits.
Please note that the information above is intended to be a summary, and all claims decisions are subject to the terms of your group’s specific insurance policy.