What do I need to know about leaving my job on disability in the US?
February 1, 2011 7:49 AM   Subscribe

What do I need to know about leaving my job on disability in the US?

I'm 58 years old, with incurable cancer, fibromyalgia and seronegative reactive arthritis. For the past 30 years I have been a sales rep on the road and can no longer handle the 1500 mile a week drive without great suffering. Without too many gory details, there is bleeding, bowel and pain involved with this disease, causing embarrassment and humiliation. I'm finding my short-term memory loss alarming, along with difficulty putting thoughts into verbal communication. I'm at the point realistically where I can no longer drive without pain medication, hence impaired.

I already have an ADA accommodation that limits me to only 45 hours a week to work, but being sales, it can not be successfully done in less than 70 hours. I have no quality of life and am frequently demoralized and depressed. Furthermore, I am caretaker, POA and mother of a brain injured 35 year old son and am overwhelmed with responsibilities that are challenging enough. He has nearly bankrupted me. I need income and can collect long term disability from my big-box bazillion dollar a year company I work for and receive about $1900/month pre-tax. (I currently make around $60K per yr and live comfortably)

The company's process is that I go on short term disability for 8 weeks (I get $74.00 per week post tax) then they transition into long term. I have limited savings because I had to make a home for my disabled son and took a second mortgage out to pay for it. He is earning $900/mo in disability, of which I take $525 of it for rent. I admit I know nothing about ObamaCare and what I will need to comply with these pre-existing conditions. I am asking your advice as to what (and when) to reveal to my manager about my doctor's supportive advice to leave work, what checklist to make prior to giving notice and any other relevant HR-type mumbo jumbo stuff to protect me from the mega-company's legal peeps. I have signed a non-compete agreement, and I have worked in the same job for three decades.

I CAN tele-commute until my condition becomes terminal, and intend on writing (my second job) and selling as many articles as my health permits. My boss has been very humane and has kept my position open during prior short term leave (6 months one time two months another for chemo) when she didn't have to, however she has moved on to a higher pay grade and cannot make those determinations in the same manner. It IS a small possibility that they value my time and great experience enough to create a telecommute position for me but that is a very remote one. Should I also apply for SSI? What other agencies can I go to for help in support and help to continue working within my limitations? I dreaded this moment, it is the end of a stellar, ethical career of which I pride myself. I want dignity at the end of my life, and most of all grace. Throwaway email: disposablemeta@gmail.com
posted by anonymous to Work & Money (8 answers total) 5 users marked this as a favorite
I'm sorry this is happening to you. You obviously have a lot on your plate.

In terms of disability..... you have to read the terms of your company's disability policy, but it certainly sounds like you would qualify for that. I'm not sure why you would not take advantage of it. You can certainly also apply for SSI - there are lawyers who specialize in that sort of thing, which might help. In both cases, make certain that whatever you're doing as your second job does not disqualify you from benefits (some disability polices kick in if you are disabled from doing YOUR JOB; other only when you are disabled from working at all). Also, make certain your health care will be taken care of - to me, this would be the biggest issue with going on disability. What happens to your work sponsored health plan? Will you qualify for medicare/medicaid? A state plan? or will all your disability income be eaten up by paying for health care?

Good luck.
posted by dpx.mfx at 8:35 AM on February 1, 2011

I'm sorry to hear you're going through this! I work for a disability insurance company - maybe yours, maybe not, but they all pretty much work the same way. A lot of the things that are variable are spelled out in your summary plan description (SPD) for your disability insurance, which you should have received as a new hire and can request at any time from your company's HR department.

The first thing you should do is talk to your employer's HR department and ask for the number for Short-Term Disability claims. You will initially speak with an intake coordinator who will ask you basic questions: How much do you earn? Is it all salary or does it include commissions? What are your work duties? What limitations do you currently have? What diagnoses have been made? Who is your Doctor?

If you don't have all that information at hand, it's not a big deal. You will be working with a claims specialist and there will be plenty of back-and-forth.

The claims specialist will then go to your employer to verify certain information. They can't share your diagnosis or prognosis but they can verify salary information, etc. The claims specialist will either contact your doctor or send you a form to have your doctor complete. All this information goes toward determining whether you are eligible for benefits. Your duties at home (your son, your mother) do not factor into this determination, just what you do at work and whether you are unable to do them.

If you're approved for benefits, then you will receive weekly checks. Typical plans pay employees 60% of their weekly earnings to a maximum of $500, $1000, or more. Depending on your employer's contract with the insurance company, this could be higher or lower. The waiting period and duration of benefits also varies. Looking at your question it would seem like you should receive much more than $74 each week, but it's hard to tell without seeing a pay stub.

Typically you'll be on Short-Term disability for 8-14 weeks (or more, depends on the plan). If you are still unable to work at the end of this period, then you will transition to Long-Term Disability. There may or may not be a gap in coverage during this time (good plans won't have a gap).

When you transition to LTD there will be another review of your information. You may begin working with a new claims specialist. They will asses whether you might be able to return to work with some modifications, and they can even pay your employer to make certain modifications to assist in your return. They can also help with money to go back to school or for other re-training for a career you'd be able to do. The monthly payment you receive will again be about 60% of your monthly pre-disability earnings, up to a maximum of $2000, $3000, or more (depends on the plan). This benefit is paid monthly. Depending on your diagnoses and prognoses, they may ask you to submit more information periodically.

Many LTD contracts contain a provision called offsetting. That's where they look at any other income you might be receiving like rental income, investment income, SSI income, and income from other work. So in your case, if your monthly pre-disability income is $5000 and 60% of that is $3000, and you earn $1000 at a second job you're still able to do, your monthly disability check will be reduced by the amount you're earning at your second job. You would then receive $2000.

The amount of time you will receive Long-Term Disability payments can vary. Some plans pay for 5 years, some continue until you're 65, and some pay until you reach Social Security retirement age for your age cohort.

All of these benefits may be taxed - it depends on whether you pay premium with pre-tax dollars (most common) or whether your employer takes it from your post-tax income (called gross-up).

There's really no way to estimate what your monthly disability payments might be without knowing a lot more about your plan. I would start with a phone call and ask lots of questions if you are even the least bit confused.

This is pretty long already, but you can memail me if you have any questions.
posted by Coffeemate at 8:52 AM on February 1, 2011 [4 favorites]

Also, if your company employs at least 50 people in the location you work at, you should qualify for FMLA, even if you don't qualify for disability. Your employer basically has to hold your job for you (or a job with similar duties, earning potential, etc) for up to 6 months so you can take care of your health issues, your parents' health issues, your childrens' health issues, or the birth or adoption of a child. It's unpaid, though.
posted by Coffeemate at 8:56 AM on February 1, 2011 [2 favorites]

Disability: I would read closely your summary plan description for your company's long-term disability. Usually the plans require that you apply for SSDI (which would then qualify you for Medicare, although not necessarily immediately), and then they integrate the SSDI with the additional benefit from the private long-term disability policy. If your state has a state disability plan (which usually kicks in immediately, but lasts for 12 months), then your company's long-term disability plan may also integrate with that. If there is an HR representative you trust, I would ask that person to walk you through the process and options. Given that you are still considering trying to keep working, I would frame your request as exploratory.

Health coverage: The company's plan may include continued health coverage. If it does not then you might need to consider COBRA, which will allow you to continue your health care until you qualify for Medicare (although you need to pay the premiums which are often high). One of our MeFites who is in HR may provide more background. (I'm just not that familiar with the health coverage if any of LTC plans.) Again, see HR representative.

Disability accommodations: There are many possible accommodations that might be available to you. I would read the EEOC's guidance on Reasonable Accommodation and Undue Hardship. It's long and a bit strangely organized, but will review the range of possible accommodations, such as a leave of absence, modified schedule, job restructuring, telecommuting, and a transfer to a vacant position. Whether these are available to you depends upon all of the facts, but the guidance document gives you a sense of the range of possibilities. Since you mentioned telecommuting, here is the EEOC's factsheet on that accommodation. You can also contact the Job Accommodation Network, a free federally funded service that provides technical assistance on reasonable accommodation.

Decision-making: It can be complicated to pursue ADA accommodations and long-term disability at the same time, for both practical and legal reasons. If you think that you can continue working with accommodations, you could pursue that first, and hold off on pursuing long-term disability. Of course, continuing to work is likely going to provide more income. Also, given your long work history, your company may provide fairly substantial accommodations if you push for them. On the other hand, long-term disability is perhaps more stable and certain. Only you can decide which path(s) to take and when.

Money: I can't tell from your question whether you think you can survive financially, with your mortgage, on long-term disability. Maybe you don't know yet. You may want to contact service organizations in your community to find out whether there are additional supports for someone in your situation.
posted by ClaudiaCenter at 9:17 AM on February 1, 2011

There's some really good practical advice here so far, but I would also urge you to consult a lawyer and/or financial planner if there's any way you can afford it to sort out how you can best take advantage of the various government support programs for yourself and your son. (I am a lawyer and I would probably consult a specialist on this if I were in your position - the regulations can be really complicated, and there are better and worse ways to do things.) If you email the mods and have them post the state and/or city you live in, we might be able to direct you to some resources.

That said, you seem like an intelligent and aware person, and there's a lot to gain by informing yourself and becoming your own advocate. In fact, even if you get professional advice, you'd need to do this anyway. NOLO press has a plain-English guide to Social Security Disability, an Estate Planning guide that includes a section on "planning for incapacity"; two guides on Long Term Care and Long Term Care Insurance (you may still be able to get this with your pre-existing condition); and one on Social Security and Medicare (also includes a chapter on Medicaid). In addition to these guides, you can find a lot of helpful information on agency websites -- the EEOC links that ClaudiaCenter posted above are great, and are mostly written to be comprehensible to the general public.
posted by yarly at 9:49 AM on February 1, 2011 [1 favorite]

Oh, and I also wanted to add that people *do* get unfairly denied short term and long term disability all the time. You'll need to read the plan documents very very carefully if you decide not to get legal advice in advance. Be sure to document *everything* in the process (send letters certified and delivery confirmation requested; take notes on phone calls) and observe all deadlines and procedures as stated in the policies and any determinations you get. If you do get denied, I would definitely urge you to get a lawyer, but keep a very close eye on those deadlines in any event.
posted by yarly at 9:54 AM on February 1, 2011 [2 favorites]

Two Nth yarly, I've known several people who went on short term disability and were unfairly denied long term disability. My cynical assessment is that insurance companies know that it costs time and lawyers to fight the determinations, and lawyers often seem to lose interest in these small-potato cases. So do, at the very least document - you already have so much on your plate that being your advocate for now may be too much for now, and hopefully you won't need to.
posted by ldthomps at 12:16 PM on February 1, 2011

We have a family friend who spent years trying to get her disability straightened out. Her experience was horrible, trying to get what she was legally due.

Before you sign anything that might lock you into limited benefits, you should speak with a disability attorney. Disability is a horrible maze for a single person to try and navigate, especially when both employers and insurers are going to do everything they can to limit your benefits.
posted by Thorzdad at 12:50 PM on February 1, 2011

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