Mental Health & Short-Term Disability

Can short-term disability be used for mental health conditions?

The everyday stressors of life during the COVID-19 pandemic left many school employees dealing with new or exasperated mental health concerns. While every organization approaches mental health benefits differently, we have received questions about an employee’s ability to use short-term disability benefits to help with mental health issues.

Check out the information below to expertly navigate short-term disability benefits as they relate to mental health conditions.

Do mental health conditions qualify an employee for short-term disability?

The answer is — it depends! First and foremost, the determination that any illness qualifies an employee for short-term disability is based on three things:

1. Your organization’s short-term disability requirements
2. How the health plan administrator or carrier interprets the plan requirements
3. A professional diagnosis of the illness

Oftentimes, carriers lean heavily on a professional diagnosis and treatment plan when evaluating whether a condition qualifies for short-term disability. The disability carrier will take into account:

• the severity of the illness, and
• whether or not it wholly and continuously disables an employee to the point that they can no longer engage in their regular work.

Does my organization have any say in whether an illness qualifies for short-term disability?

If your organization’s short-term disability benefits are fully insured (administered by a carrier), the carrier will determine whether an illness qualifies based on the criteria listed above.

If your organization’s short-term disability benefits are self-insured, your organization can decide whether an illness qualifies using the criteria above.

NOTE: Determinations should be made on a universal and reasonable basis. It is also important that all determinations, as well as the determination process, be adequately documented.

How should we handle short-term disability requests that are submitted due to mental illness?

We recommend following four simple steps to help your organization handle short-term disability requests for any type of illness:

1. Clearly and adequately communicate plan requirements with employees. Make sure plan certifications are distributed to ALL employees to help create a baseline understanding of what the plan provides.
2. File claims early and include all required documentation for appropriate healthcare professionals. This helps the process move as quickly and smoothly as possible.
3. Take ALL mental health claims seriously. Maintain a sensitive and professional approach when assisting employees who are looking for any type of mental health support.
4. Take advantage of your resources! If employees are requesting more mental health support, reach out to all partners, such as your SET SEG account executive, Employee Assistance Program (EAP), and insurance agent.