Disability Management Best Practices

Disability Claim Management FAQs

Who can report a disability claim? 

Any of the following can initiate the report of a disability claim: 

  • The employee 
  • The employee's supervisor 
  • The employee’s family member

What should I do once the disability has been reported? 

Depending on your company's policies and timekeeping system, you, as the manager, may need to notify Human Resources and the payroll department of the employee's absence. You may also need to enter the information in the company's timekeeping system.

Man and women having a meeting

What should I share with coworkers about my employee’s absence?

It is common for coworkers to express concern and be inquisitive about the reason for the employee's absence. Personal or medical information is confidential, and even if the employee has chosen to share the reason for his or her absence with you, you should not discuss it with the employee's coworkers. It is also common for coworkers to be concerned about how this absence will affect their own schedules and workload, which is appropriate for you to address.
 

What happens when a disability claim is approved with a return-to-work date?

In this instance, the claim manager will contact the employee and you to notify both of you of the expected return-to-work date.
 

Why did the employee’s pay stop even though the claim is still pending?

An employee’s pay may stop before a claim decision is made if the claim manager has not yet received the information necessary (from the employee or the employee's physician) to make a claim decision.

For certain policies, federal regulations (Employment Retirement Income Security Act of 1974, or ERISA) specify that employees have a minimum of 45 days to submit requested information on their claim.  The claim manager cannot deny a claim before 45 days have passed if the necessary information to make the claim decision has not been received. There may be instances when we extend this time to gather more information.

Things you should consider:  
Your employee may contact you about why his or her pay has stopped. You should refer the employee to the claim manager.

Return-to-work discussions should involve the claim manager when a claim is still pending. This will ensure proper planning is taken into consideration regarding documentation and a return-to-work release.

If you have any questions, please contact the claim manager.

My employees have to use a certain number of sick days (in this example five days) before they’re eligible for short-term disability. Do I report the disability their first day out or after they’ve used their five sick days?

The first day out for illness or injury is the "first day of absence" for the disability. The disability should be reported as soon as it is known that the absence will be longer than the five business days your employees are required to use before they are eligible for disability benefits.
 

My employee wants to return to work tomorrow, but I don’t have a work release. What should I do?

Call the disability claim manager to discuss it. The claim manager will tell you if a formal work release is required.
 

My employee reported a short-term disability claim three days ago. What is the decision?

Short-term disability claim decisions are generally made within 10 days of receiving the initial claim. After the claim is filed, a claim manager contacts the employee by phone to discuss the claim process. We may contact the manager (for a description of the employee's job requirements) and the employee's medical provider (for medical reports). This information will help us determine if the employee is eligible for benefits and how long the absence may be.
 

There are rumors that an employee on disability is working elsewhere. What should I do?

This is important information that should be communicated to the disability claim manager. Report this immediately, and he or she will investigate the validity of the report and any potential impact on benefits eligibility.


This material and page are not intended for use with residents of New Mexico. 

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