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Short-Term Disability Insurance

What is short-term disability insurance?

Short-term disability insurance pays a percentage of your salary if you are unable to work because of a sickness or injury (excluding on-the-job injuries, which are covered by workers’ compensation insurance). A typical short-term disability insurance policy provides you with a weekly benefit equal to 60%-70% of your wages, or a predetermined fixed dollar amount. The weekly benefit will vary depending on whether you purchase an individual insurance policy or a group insurance policy.

As the name implies, short-term disability insurance is for a short period of time – usually either 13 weeks (3 months) or 26 weeks (6 months). While the duration is short, the benefits are designed to begin on the first day following an accident and 7 days following the onset of a sickness.  This assumes you submit a timely claim and the insurance company does not delay processing the claim.

To avoid interruption in your income, the key is to file your application as soon as possible – don’t delay.

Feeling frustrated and unsure when filing a short-term disability insurance claim is normal. The insurance policies can be confusing and hard to read. The insurance company claim representatives are not much help and often make things more confusing and frustrating. This is no accident.

Insurance companies do not make money paying short-term disability insurance claims. That is why they put hurdle after hurdle in your way, from requesting more information to simply delaying a claim decision. With each hurdle, the insurance company is counting on you giving up or missing a key deadline. Either way, the insurance company wins and avoids paying your short-term disability insurance claim. The stress and uncertainty that comes with the claim process can be daunting. But it doesn’t have to be.

Let an experienced attorney guide you through the short-term disability insurance claim maze.

You should have access to the most experienced legal representation when fighting a short-term disability insurance claim. Grabhorn Law provides you with a free initial consultation with our experienced staff.  You receive personalized and reassuring guidance throughout the claim process. Our goal is to minimize your stress and anxiety while working to obtain a positive outcome on your claim.  At Grabhorn Law, practicing law is our profession, but protecting your Insured Rights™ is our passion.

Filing A Claim

Time is of the essence – Do not delay filing your short-term disability claim. Here are some helpful tips.

Read your insurance policy.

  • If you do not have it, request a copy of the insurance policy, in writing.
  • Make sure you receive the insurance policy, not just a certificate of coverage.
  • Read the entire insurance policy.
  • Make sure you understand what you need to submit in order to receive your short term disability insurance benefits.
  • Confirm any deadlines that could affect your claim.
  • If you have questions about what you need to submit in order to receive benefits, ask (in writing).

Cooperate with the Insurance Company.

  • An easy reason for an insurance company to deny your claim is if you do not cooperate.
  • If you do not cooperate, the insurance company will not address the substance of your claim.
  • The insurance company will simply blame you for the denial.  Don’t let this happen to you.
  • Insurance companies often require their own forms be completed.
  • You should cooperate and complete the requested forms.
  • If you’re unsure if a form is actually necessary to process your short term disability insurance claim, ask.

Do everything in writing.

  • This tip is worth repeating: Always document your dealings with an insurance company.
  • Even if you cannot send a letter or email, keep a journal and record the date, time, name and phone number of who you spoke with, and the details.
  • This goes both ways.  Always ask the insurance company (or anyone acting on their behalf) to send any requests, decisions, or information in writing.
  • When sending  a letter, make sure to (i) date the letter and (ii) keep a copy of the letter and posted envelope.

Ask questions about other benefits.

  • It is common to have other insurance benefits (life insurance and long term disability) affected by a claim for short term disability benefits.
  • Ask the insurance company, in writing, if you are eligible for any benefits.
  • If there are other insurance benefits, ask how you should submit a claim.
  • In many instances, the insurance company will automatically begin the claim process for other insurance benefits.  But make sure.

Ask what else is needed for your short-term disability claim to be approved.

  • Each time you are in contact with the insurance company, ask what is needed to approve your claim.
  • Continue to ask until the insurance company makes a claim decision.

Make sure you know the insurance company’s deadline for making a decision.

  • Under most state insurance laws, the insurance policy terms, and ERISA, insurance companies have a deadline to make a claim decision.
  • Hold the insurance company to the deadline.
  • If the insurance company misses the deadline, while it does not mean the claim must be paid, it can work to your advantage.
  • Do not delay.  Immediately contact an attorney experienced with short-term disability insurance claims.

Filing An Appeal

Time is of the essence – Do not delay in filing your short-term disability appeal. Here are some helpful tips.

Confirm whether ERISA or state insurance applies.

  • Determining whether ERISA or state insurance law applies to your short-term disability is critical.
  • Do not assume ERISA applies just because the insurance company says so.
  • Write and ask your employer if the short-term disability benefits are a payroll practice.
  • If still unsure, contact an experienced attorney (test them by asking to explain the payroll practice exception).

File Your Appeal.

  • Generally, you only have 180 days to file your appeal.
  • If you do not file an appeal, your claim will be closed.
  • You do not have to submit new information.
  • You are entitled to a fresh review of the existing evidence.
  • But, if you have evidence to rebut the denial letter, submit it.

Ask for a Complete Copy of Your Claim File.

  • Make sure to review the claim file completely.
  • Note any errors in the denial letter.
  • Review the insurance policy and make sure the correct language is being applied.
  • If applicable, ask your employer for a copy of the plan document.
  • Correct any errors when you file your appeal.

Prepare your evidence.

  • Get a copy of your medical records from your doctors.
  • Ask your doctors to note your limitations and restrictions that prevent you from working.
  • Ask your doctors to note the side effects from your medications.
  • Show the doctors the claim denial letter and ask to comment on it (why they disagree).
  • Provide affidavits (statements) from your family, friends, and prior co-workers confirming your work limitations.

File your appeal in writing.

  • Always document your dealings with an insurance company.
  • Even if you cannot send a letter or email, keep a journal and record the date, time, name and phone number of who you spoke with, and the details.
  • This goes both ways.  Always ask the insurance company (or anyone acting on their behalf) to send any requests, decisions, or information in writing.
  • When sending  a letter, make sure to (i) date the letter and (ii) keep a copy of the letter and posted envelope.
  • Even if you only submit a one-page note stating your appeal, make sure you file the appeal.

Ask the insurance company what else is needed for your short-term disability appeal to be granted.

  • Each time you are in contact with the insurance company, ask what else is needed to approve your claim.
  • Continue to ask until the insurance company makes a claim decision.

Make sure you know the insurance company’s deadline for deciding your appeal.

  • Under most state insurance laws, the insurance policy terms, and ERISA, insurance companies are only permitted 45 days to decide your appeal.
  • Hold the insurance company to the deadline.
  • If the insurance company misses the deadline, while it does not mean the claim must be paid, it does work to your advantage.
  • But you cannot delay.  Immediately contact an attorney experienced with short-term disability insurance appeals.

 

 

 

Filing A Lawsuit

Time is of the essence – Do not delay in filing your short term disability lawsuit. Here are some helpful tips:

Do not delay.

There are strict deadlines for filing a short term disability lawsuit. The insurance policy may limit this time period, as well as state law. Time is not your friend.

Do not be afraid of filing a lawsuit.

It’s your legal right. Yes, it may take time, but it’s the only way to obtain the short term disability insurance benefits you are owed. If you use an attorney, you can be involved as much or as little as you like. Your attorney should make the process as smooth and stress-free as possible.

Look for an experienced law firm.

Not every law firm has experience with short term disability insurance claims. Make sure the law firm you choose has experience in dealing with not only your short term disability claim, but also with your medical condition and your insurance company.

Look for a law firm willing to try your case.

Although the majority of short term disability lawsuits resolve prior to a trial or judgment, if your case does not, you need to make sure you have a law firm experienced in successfully pursuing a short term disability lawsuit to a final decision.

Location should not matter.

You should not limit your choice of an attorney based on whether they are located near you. The most important factor should be experience, followed by your comfort level. And with today’s technology, there’s no reason you can’t have both.