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.