Short-term disability insurance coverage can be invaluable if you are dealing with a medical condition that is impacting your ability to work.
It can help cover living expenses, medical bills, and other costs associated with being unable to work, so you can focus on what’s most important: getting better.
Unfortunately, disability insurance companies make the process of qualifying for benefits overly complicated and difficult. They prioritize their own financial interests, meaning they will often do whatever they can to deny a disability claim, even if it means finding a flimsy excuse to do so.
This can be incredibly frustrating and disheartening for anyone who is already struggling with a disability and needs financial support.
In this article, we’ll help you to understand some of the most common reasons why a short-term disability claim can be denied and what to do if you are faced with a denial.
What we’ll cover:
- How does short-term disability work?
- 7 reasons short-term disability can be denied
- Your short-term disability claim was denied. What now?
How does short-term disability work?
Short-term disability insurance can replace a percentage of your income if you cannot work due to a qualifying medical condition. With much shorter waiting periods and fewer restrictions than long-term disability, short-term disability can provide much-needed help in making ends meet.
Before we get into the reasons why short-term disability claims can be denied, here’s a general overview of how this type of insurance plan works.
Qualifying for coverage
Short-term disability insurance is typically employer-sponsored, but you can also purchase it yourself (at a much higher cost).
To qualify for short-term disability benefits, you may need to meet certain eligibility requirements, such as working a certain number of hours per week or being employed for a certain length of time. Your medical condition will also need to be covered by the policy.
Filing a claim
If you cannot work due to a qualifying medical condition, you will need to file a claim with your disability insurance company. This typically involves providing medical records, physician statements, and other required information as evidence that the condition prevents you from working.
Your insurance company might also require you to participate in an Independent Medical Exam or a Functional Capacity Evaluation. If you receive such a request, you should contact a disability lawyer immediately.
There is typically a waiting period, also known as the “elimination period,” before you can receive benefits. This waiting period can vary depending on the policy but is usually only between one and 14 days.
Short-term disability plans have a much shorter waiting period than long-term disability plans, which typically have a waiting period of 90 days. This makes short-term disability a great option to help bridge the financial gap while waiting for approval of your long-term disability claim.
Once your short-term disability claim is approved, you will receive a percentage of your pre-disability income (usually about 60-100%) for a specific benefit period, which is typically three to six months. The length of the benefit period will depend on your policy.
Returning to work
If you are able to return to work before the end of the benefit period, your benefits will typically end. If you are not able to return to work, you may need to apply for long-term disability benefits.
7 reasons short-term disability can be denied
Short-term disability benefits can be denied for several reasons, including:
1. Insufficient medical evidence
To qualify for short-term disability benefits, you must provide medical documentation that proves you are unable to work due to a medical condition or injury. If the medical evidence is incomplete or insufficient, your claim can be denied.
2. Failure to meet eligibility requirements
Short-term disability benefits are typically available to employees who have worked for a certain period and are covered under the employer’s disability insurance policy. If you do not meet the eligibility requirements, your claim can be denied.
3. Pre-existing conditions
Some disability insurance policies exclude coverage for pre-existing conditions. If your condition was present prior to you being covered by the policy, your claim can be denied.
4. Failure to follow treatment
If you fail to follow the prescribed treatment plan for your medical condition, such as taking medication or attending physical therapy sessions, your claim can be denied.
5. Missing or incomplete information
If you fail to provide all the necessary information or documentation required to process your claim, your claim can be denied.
6. Lack of disability
If your medical condition does not meet the definition of disability as defined by the insurance policy, your claim can be denied.
7. Fraudulent claims
If the insurance company suspects you are making a fraudulent claim or misrepresenting your medical condition, your claim can be denied. Insurance companies always monitor benefits recipients in search of a reason to cut off benefits.
For example, in the landmark case of Flaaen v Principal Life Insurance, Principal Life Insurance had incorrectly assumed something based on a social media post, causing them to deny Flaaen’s benefits. However, Roy Law Group identified the major mistakes in Principal’s argument and ultimately overturned the denial.
Your short-term disability claim was denied. What now?
If your short-term disability claim has been denied, it’s important to act quickly, as there will be deadlines for filing an appeal or taking legal action. You might feel frustrated and overwhelmed, but don’t give up. You still have options.
Here are several steps you can take:
1. Review the denial letter
Carefully review the letter from the insurance company explaining the reasons for the denial. Understanding why your claim was denied can help you determine what steps to take next.
2. Gather additional information
If the denial was due to a lack of medical evidence or incomplete information, gather any additional documentation that might support your claim.
3. Contact the insurance company
If you disagree with the denial, contact the insurance company to discuss the decision and try to resolve the issue. Be prepared to provide additional information or documentation to support your claim as requested.
4. File an appeal
If you are unable to resolve the issue with the insurance company, you may need to file an appeal. This typically involves submitting additional documentation and explaining in a letter why you believe the denial was incorrect.
Review the policy to determine the specific appeal process and deadlines. After you receive the denial letter, you typically must file an appeal within 180 days.
Keep in mind that the appeal process can be lengthy and complicated, so it is important to be patient and persistent in pursuing your claim.
5. Seek legal advice
We strongly encourage you to seek legal advice when filing a disability claim or appeal. An attorney specializing in disability insurance claims can help you understand your rights and options.
Get expert advice today
Our team at Roy Law Group specializes in disability insurance law, and we go to battle against major insurance companies every single day. The appeal process is complicated by design, and you are no match for the insurance company’s endless resources. Our disability law experts know what pitfalls to watch out for when filing a claim or appeal and can handle the entire process for you.
Contact us today for free advice about your claim.