In the short term, termination during sickness or disability is legally prohibited. However, if your employer can substantiate that the termination is unrelated to the disability, they have the legal authority to dismiss you even while you are on sick leave. (Learn more on signs you will be approved for disability)
Reasons For a Short-Term Disability Denial
Short-term disability claims may be denied for several reasons, often stemming from inadequate documentation or failure to meet specific criteria. Some reasons are as follows:
- Insufficient Medical Documentation: Claims require comprehensive medical evidence to support the disability claim. Inadequate or unclear documentation can lead to denial.
- Pre-existing Conditions: If the disability is related to a pre-existing condition, some policies may have exclusion clauses. Insurance providers may deny claims if they believe the disability stems from a condition existing before the coverage period.
- Failure to Meet Waiting Periods: Short-term disability policies often have waiting periods before benefits kick in. If the disability resolves before this waiting period ends, the claim may be denied.
- Disputes Over Disability: There may be disagreements between the claimant, healthcare providers, and insurers about the nature and severity of the disability, leading to denial.
- Failure to Follow Treatment Plans: The insurer may deny the claim if the claimant does not adhere to prescribed treatment plans or refuses recommended therapies.
- Lack of Occupational Impact: Some policies require the disability to impact the individual’s ability to perform their specific occupation. If the disability doesn’t meet this criterion, the claim may be denied.
- Failure to Provide Timely Notification: Promptly informing the insurer of the disability is crucial. Delays in notifying the insurance company can be grounds for denial.
- Failure to Cooperate with Insurer’s Investigation: If the claimant does not cooperate with the insurer’s investigation or fails to provide the requested information, the claim may be denied.
Understanding these reasons can help individuals navigate the process, ensuring they meet all requirements and provide the necessary documentation for a successful short-term disability claim. (Get detailed information on How Does Short-Term Disability Work?)
My Short-Term Disability Claim Was Denied. Now What?
If your short-term disability claim has been denied, it can be a challenging situation, but there are steps you can take to address the denial:
- Review the Denial Letter: Carefully examine the denial letter from the insurance company. Understand the specific reasons for the denial, as this information will guide your next steps.
- Consult Your Policy: Refer to your short-term disability policy to understand the terms, conditions, and requirements. Ensure that you are aware of any deadlines for appeals and the procedures outlined in the policy.
- Gather Additional Documentation: If the denial is based on insufficient medical documentation or other evidence, work with your healthcare providers to gather comprehensive and clear documentation supporting your disability.
- Appeal the Decision: Most insurance policies provide an appeals process. Prepare a well-documented appeal that addresses the reasons for denial. Include updated medical records, doctor’s opinions, and other relevant information.
- Seek Legal Advice: If your appeal is unsuccessful, consider consulting with an attorney specializing in disability law. They can provide guidance on the best course of action, including potential legal avenues. (Read more on how to find a good disability lawyer?)
- File a Complaint: If necessary, you can file a complaint with the appropriate regulatory agency overseeing insurance practices in your jurisdiction. This step may prompt a review of your case.
- Explore Alternative Options: While navigating the appeals process, explore other financial options such as sick leave, personal savings, or any available state disability benefits.
- Maintain Communication: Stay in communication with your insurance company throughout the process. Timely responses to requests for information or additional documentation can help expedite the review.
Disability Claim Denied? Talk To An Attorney
A Social Security Disability lawyer can assist in a short-term disability denial by leveraging their expertise in disability law. They can evaluate the denial reasons, gather relevant medical evidence, and build a strong case for appeal. Furthermore, they navigate complex legal procedures, increasing the likelihood of an appeal and pursuing the SSDI or SSI benefits.