Short Term Disability "Qualifying Event" Question

SummerAngel · April 2015

In terms of BC, what is a "qualifying event" for disability? I'm attempting to use my paid time off for my initial BMX and then if I need chemo or if I do a DIEP Flap reconstruction I'll use short term disability for one (or both) of those. My HR rep (who clearly has no idea about cancer treatments) is telling me I must use short term disability immediately, as if the diagnosis of cancer itself is the qualifying event. Is that true?

SpecialK · April 2015

For me STD (a benefit for which I paid the premium) did not kick in for 15 working days, so I had to use PTO for those, but I did start using it at the time of BMX because I needed 4-6 weeks off and did not have enough PTO available. Are you having expanders placed at the time of BMX - if so, how long are you projecting to be out of work, and do you have enough PTO to cover that? Are you using FMLA concurrently with your PTO and/or STD? My understanding about FMLA is that it is necessary to file for it after using 3 days of "sick leave" or PTO to document the absence and to protect your job, otherwise if you are not deploying FMLA you don't have job protection. Do you have Long Term Disability insurance benefits available? Many STD policies have an end point - mine was 12 weeks, so my FMLA and STD ran concurrently. I switched over to LTD (employer paid) after the STD ran out because I had more surgery, then chemo.

muska · April 2015

Your BMX surgery is a qualifying event. Usually, FMLA kicks in at the same time, i.e. you are covered by FMLA while you are on short term disability for surgery and subsequent treatment if needed. If I recall correctly, there are special rules for cancer patients who are on chemotherapy: STD/FMLA coverage in such cases does not need to be continuous, e.g. you can take separate days or even hours off for chemo treatment over an extended period of time and be covered by FMLA. I would recommend you discuss all the details upfront with your HR and insurance provider.

I took five weeks of continuous STD/FMLA coverage for BMX surgery, returned to work, and continued taking sick time that in my company, is covered by STD on the days of my chemo infusions and as needed through the end of a year long treatment.

SpecialK · April 2015

Not taking continuous time off is called "intermittent" FMLA but it has the same time limit as FMLA that is taken as a continuum, which is 12 weeks. Once you burn those 12 weeks in any 12 month period you are out of FMLA, regardless of the illness. I used all of my FMLA prior to chemo because I had five surgeries over that 12 week period so my FMLA and STD were gone, but was fortunate to be granted an ADA (Americans with Disabilities Act) accommodation, which ran concurrent with LTD. This was offered by the HR department, I did not request it - they were very helpful in arranging all of this. The only reason this was done, and I was not let go, is that we had closed a lab and had a bunch of personnel who could fill my spot until the new lab location opened. My company did not endure any financial hardship not having me at work so they were willing to do this.

pajim · April 2015

SummerAngel, so far as I know the"qualifying event" is whatever event requires you to be out for more than the number of days your company uses before STD kicks in. At my place it's 10 days. Your breast cancer diagnosis could be the qualifying event, but it doesn't require you to take STD right away?

My company is weird because we self-insure for STD so they were happy if I wanted to work some of the time. My HR department and I worked together to get the right paperwork for what I wanted. Basically my oncologist filled out STD paperwork, but in the box where it said "how long will she be out" he wrote "may work as tolerated". Everyone was OK with that. I'm not sure that would work for you -- it depends on the insurance company.

muksa & specialK likely know better. Your HR rep needs to get some education.

SummerAngel · April 2015

Thanks for the replies! I guess I'm still a bit confused, and my HR person isn't any help. I plan on having a BMX with expanders. I'm unsure of the type of reconstruction as I have consultations this week. It will either be implants or DIEP flap, and if I go the DIEP route the main surgery for that will be delayed and of course the recovery will be a lot longer than if I do the implants. I have about 5 weeks of paid time off available, and I would like to take about 2-3 weeks of that for the BMX. I work 100% of the time from home, on the computer, so my job is not taxing. I'm also a very quick healer with a very high pain tolerance, so I think 3 weeks max should be enough. I'd like to apply for and have the STD kick in for the reconstruction, or maybe chemo if I need it (not known yet). It would be great if I can take a few days of STD at a time for chemo if necessary! My STD limit is 12 weeks I believe (kicks in after one week of the "qualifying event"), and we do have LTD I can move to if necessary (I hope not).

SpecialK · April 2015

summerangel - if you have that much PTO, and you are not required to state why you are taking the time off, it seems like you could use that time for the BMX and file for the FMLA/STD for either chemo or your recon. I am not sure why you would have to use the surgery as your qualifying event if you are not deploying the FMLA/STD to protect your job until then. Is there anyone at your HR besides the person who is clueless?

justmaximom15 · April 2015

Simple question here, and I'm a Benefits Administrator. Why do you want to use PTO instead of STD for the BMX? To me that's like giving up a much earned benefit.

SpecialK · April 2015

justmaxi - Not to answer for the OP but I think she wants to preserve her STD for the potentially longer treatment and recovery. If she has a 12 week STD/FMLA limit like I did, my chemo was 15 weeks long so I exceeded both STD and FMLA. If she does a DIEP the recovery is longer than for other types of surgery - and she could conceivably have to do both.

lbrewer · April 2015

Summer,,

I worked from home about two weeks after my diep. FMLA is not paid leave to the best of my knowledge it just guarantees your job. I was allowed to use sick leave and only use a half day per day and worked two weeks at half time and then went back full time after two weeks. So out two weeks, half time for two and then full time. And I am no pain warrior!

Policies may differ as to when yiu can use short term disability and how long it lasts. I was not out long enough for it to cover.

lbrewer · April 2015

I also worked full time all through ACT chemo. Just the day off for chemo and then from home Was fine since I am close to a bathroom!

justmaximom15 · April 2015

That may be the answer but if she doesn't need that much time and takes PTO first then she's basically lost out on getting those STD weeks and she's out PTO as well. Does that make sense? If you first take the STD then if you still need time then take PTO for the DIEP.

SummerAngel · April 2015

You're absolutely correct, SpecialK. If I need chemo I will need the STD for that. Same with the DIEP if I go that route. My STD is 60% of my salary. Tax-free, yes, but I hit the maximum benefit cut-off and my weekly pay will be less than my typical salary by a decent amount, even after taxes.

I agree that there shouldn't be a reason I have to use the STD right away, unless the cancer diagnosis itself is the "qualifying event", which the HR person seems to think it is. There may be another HR person I could talk to, but the one I did speak to gave me the contact information for the STD provider contact (Cigna). I've sent that contact an email about this, no response yet.

Thanks again!

SummerAngel · April 2015

Thanks for the additional responses about time off! It would be wonderful if I don't need to take a bunch of time off for the DIEP or chemo! My goal is to minimize financial impact. I'm a single parent to three teens, one in college.

justmaximom15 · April 2015

Our plan is self insured and paid through company payroll. Since you used the term "tax free" I'm assuming that you are actually covered by a third party and they pay you the gross amount of 60% of your salary? Just a note, it is taxable so you will have to include that in your taxes for 2015, you'll probably get a 1099 or something from the company.

If this is the case then it somewhat answers my question about why you don't want to take STD now but you should have a summary plan description that you can read that gives all the details of the plan and I would advise that you read that thoroughly. As I mentioned, our plan is self insured and paid through payroll so oftentimes someone will take STD then add PTO to whatever they need to make up a full check. Your STD plan may not allow that though.

Tempy · May 2015

I'm in a bit of a pickle between a rock and a hard place. Started a new job beginning of February and diagnosed on April 20. No FMLA available for me because I don't have the hours in and the facility I work for only offers STD and/or AFLAC during "benefit fairs" in July and November. Hopefully they won't deny me because it's pre-existing even though I wasn't diagnosed when I started the job.

justmaximom15 · May 2015

Did they not offer the STD / Aflac when you were first hired?

Tempy · May 2015

Nope not offered upon first hire only at the benefit fair as external reps have to come in to sign up. Goofiest thing I've ever heard of but here I am ...

Short Term Disability "Qualifying Event" Question

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