Filing a Disability Benefit Claim
Understanding your options
Washington Paid Family and Medical Leave (WAPFML)
Employees may be eligible if they have worked at least 820 hours for any Washington employer in the last 12 months. The Employment Security Department (ESD) determines eligibility. Eligible employees may receive up to 12 weeks of family leave (to care for a family member or bond with a new child), or 12 weeks of medical leave (self-care), or a combination of the two, up to 16 weeks, annually.
PFML provides partial-income replacement up to 90% of the employee’s weekly wage, the minimum payment is $100 a week and the maximum is $1,327 a week. This program has a 7-day disability waiting period. For more information on the program visit https://paidleave.wa.gov or view this FAQ. If you are facing a financial hardship you can attempt to request an expedited review of your claim, visit https://paidleave.wa.gov/hardship.
The claim application process is online. Employees submit a section of the claim. Employees need to have a treatment provider complete the Certification of Serious Health Condition form that they then need to scan and upload to their online claim portal.
The King County Benefits Office will be contacted by ESD once the claim is submitted, and they will complete the Employer Section. Once employees receive a mailed correspondence of approval to this program, they should log back into the online portal and certify each day and/or week they are off work and not receiving pay from King County pay to receive the WA PFML payment via direct deposit.
Employees are required to notify King County that they intend to apply to this program per its policies.
Standard Long-term Disability (LTD)
LTD claims are administered through a third-party company called The Standard Insurance Company (The Standard). Employees can submit a LTD claim at any point; they do not have to wait until they are off work to submit a claim. The disability waiting period for LTD is 90 days (# of days off work due to disability that must be fulfilled prior to receiving any potential payments). The King County Benefits, Life, disability, and other insurance website contains additional information.
The Standard will determine the disability date based on the information they gather from all sources (documentation and information from treatment providers and King County).
To initiate a claim, employees can call The Standard at their claim intake line at 1-844-239-3567 to complete the Employee Section of the application over the phone (King County’s policy # is 752580); starting a claim over the phone is the quickest and easiest way and what The Standard prefers.
Or employees can complete the application form and submit the paperwork to The Standard via either:
- Mail: Standard Insurance Company, PO Box 2800, Portland, OR 97208
- Fax: 800-378-6063
The attached paper claim application also includes the Employer Statement and Attending Physician Statement sections of the claim. Once employees submit the Employee Section into The Standard (via phone/fax/mail) then The Standard will send King County’s Benefits Office an email for the Employer Statement section of the claim to be completed. The Benefits Office will forward this emailed link to the employee’s department human resource representative for them to review and complete. Employees are ultimately responsible for having their treatment provider complete/return to the Attending Physician Statement section of the form into The Standard so that they can adjudicate their claim.
If LTD is approved, payments can be up to 60% of pre-disability earnings (The Standard does count all sources of deductible income to include WA PFML, Worker’s Compensation, and sick leave accruals, etc.) and can continue until the employee returns to work. If the employee is not able to return to work due to their medical condition(s), payments can continue after employee leaves King County. In most cases if the disability remains the same then payments continue for up to two years and then The Standard reviews LTD claims on a more holistic approach to determine if the disability prevents the employee from not only working their regular occupation but any occupation. If The Standard finds that the employee is disabled form working any occupation, LTD payments can potentially continue until the employee has reached 65 years old. If the disability that prevents an employee from work is solely mental health related, The Standard LTD payments are only issued for to a total of up to 2 years (per their policy).
If an employee fulfills their 90-day LTD disability waiting period prior to leaving King County, they become eligible for waivers for Life Insurance, AD&D and LTD premiums for the duration that they receive LTD benefits. Additionally, if LTD is granted, The Standard would assist the employee with applying to SSDI through their third-party contractor called ALLSUP.