Insured Rights™ | Call (877) 244-9331

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.