Getting Disability Benefits When You Can't Work After an Injury or Illness

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Getting Disability Benefits After a Serious Illness or Injury

One of the questions that we hear most frequently from people on long-term disability and people who have been injured at work is:

"When do I know if I am supposed to use my PTO, my sick leave, or my insurance claim? How can I tell what I am supposed to do if my human resources department is telling me to drain my PTO or sick leave, but I think I'm supposed to be using insurance?"

These are difficult and complicated questions.

Here's how it works for workers' compensation:

When you are hurt at work, you are supposed to report the claim immediately to your supervisor (called timely notice) and file an incident report. Document whatever you can. Tell human resources that your injury happened at work, and you would like to file for workers' compensation immediately.  And go see a doctor - by law, you can choose your own doctor when you're hurt at work in D.C. and Maryland - so don't let your company or the insurance company send you to a doctor or some kind of "Workers Comp Clinic."

From that point forward, you shouldn't be using your bank of paid time off from your employer if you have one. But you have to make sure you have a note from your doctor taking you out of work and relating the injury to the accident at work. That's what the workers comp insurance company needs to pay your weekly benefits.  There will always be some delay getting the claim set up after an injury, but that shouldn't last more than a week or two.  

For long term disability:

When it comes to long-term disability, it's a little bit more complicated because you may may have to file for short-term disability first, and that has to be thoroughly documented by medical treatment. You may have to use some of your PTO or sick leave while your medical treatment is being documented. But as soon as you have support and medical evidence for your claim, you should file for short-term disability. Once the you start receiving short term disability from the insurance company, you don't need to take leave or PTO.

There are also a number of exclusions and offsets in long term disability policies that you will need to be aware of and that can impact your legitimate claim for benefits. A lot of this will depend on your specific disability insurance policy.

And remember, your HR department, supervisor, co-workers - they can all give you well meaning advice and try to help, but they rarely, if ever, really understand long term disability or workers compensation.  They are both complex systems, so be careful who you listen to.

There are lots of nuances and exceptions to rules in short-term disability and long-term disability claims, so if you have a question please call us at (202) 393 - 3320 to set up a consultation with me. With us on your side, you can get the information you need to avoid the classic mistakes that most people make when they are dealing with insurance companies.

Frank R. Kearney, Attorney-at-Law
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Experienced DC Workers' Comp, Long Term Disability & Accident Lawyer