Special Cases: Unique Medical Situations
If any of the following situations apply to your patient’s case, we may need to get additional medical forms or documentation from you.
If your patient’s disability is solely caused by abuse of an illegal substance, he or she may still be eligible for Temporary Disability Insurance benefits. However, you will need to certify that your patient is, as far as you know, currently drug-free and enrolled in an inpatient or outpatient rehabilitation program. Benefits may only be issued while he or she is in a rehabilitation program
Your patient may be mentally unable to handle his or her own affairs, including the use of benefits; for instance, the patient may be in a coma, or institutionalized for a psychiatric disability. In these cases, we may ask for a certification from you that your patient is currently unable to handle his or her affairs. In order for these benefits to be paid, the division of Temporary Disability Insurance will need a financial power of attorney from your patient’s representative.
Benefits will not be paid to applicants whose disability occurs when they willfully and intentionally injure themselves. While this does include suicide attempts, benefits may still be payable if an underlying medical condition (e.g., depression or anxiety) is part of the diagnosis.
If the surgery is reconstructive in nature to correct an underlying disabling condition, benefits may be payable. However, if the surgery is solely for cosmetic reasons, benefits will be denied.
If your patient is donating an organ, benefits will only be payable from the date of the surgery, not for any pre-admission testing.