Disability Basics

A person who is unable to work as a result of an injury or illness may be considered disabled. According to the Washington Business Group on Health, each year more than three-quarter of a million Americans experience injuries or illnesses that keep them out of work for five months or longer.

But disability is not solely defined by a person's health condition; it is also defined by the effect of the impairment on the person's capacity to work. A person whose health is impaired may not necessarily be disabled.

Take any two individuals with the same diagnosis. One may be minimally impaired and able to function on the job and in his or her daily life, while the other is incapacitated. Factors such as age, gender, attitude, strength, co-morbidity (multiple diagnoses, both medical and/or psychiatric) and environment all help determine if a person is impaired or fully functional. What determines if they are disabled is the employer's disability contract.

Disability benefits and Workers' Compensation are both partial payment for lost income due to injury or illness, but they are different. Workers' Compensation replaces income and pays medical expenses for job-related illness or injury. Disability benefits do not pay medical expenses, and depending on the employer's contract, may or may not cover work-related disabilities.

Because many employers do not have the in-house expertise to make disability claim decisions, they hire disability vendors (insurance companies, third-party administrators) to administer and clinically case manage their disability claims. Employers determine what they offer their employees in their disability benefit contract, specifically:

• the scope of disability benefits: only short-term disability,only long-term disability, or both; and
• types of disability benefit plan policies: paying benefits only if an employee is unable to perform the duties of his/her regular occupation or paying only if the employee cannot work in any job at all.