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Some injuries, illnesses, and medical conditions only prevent you from working for a short period of time. When you’re recovering from surgery, allowing time for a broken bone to heal, or even contending with pregnancy, short-term disability insurance can step in with temporary wage replacement.
By using short-term disability insurance, you can keep up with your monthly expenses even without your regular paychecks. This coverage can bridge your income gap while you attend to non-work-related injuries, physical illnesses, mental health conditions, pregnancy and childbirth, and surgery and rehabilitation.
Unfortunately, denial rates are fairly high for short-term disability, with some reporting that it is at least 50% of all cases or higher. If you need to make a short-term disability claim, it is important to understand the reasons disability claims may be denied to avoid potential pitfalls.
Why Is Short-Term Disability Denied?
There are quite a few reasons why your short-term disability claim might be turned down.
Insufficient Medical Evidence
One of the most common reasons short-term disability is denied is that applicants fail to provide complete medical documentation of their condition or injury. Before applying, make sure that you have proper medical evidence to submit to the insurer. To that end, you should also ensure every section is filled out on the form to avoid rejections based on missing information.
Failing to Meet Eligibility Requirements
In order to qualify for short-term disability benefits, your employer likely requires you to have worked for them for a certain period of time and have coverage under their policy. If you haven’t been working with your company long enough, you may not meet these requirements.
You Have a Pre-Existing Condition
With some short-term disability policies, coverage is excluded for pre-existing conditions. Make sure you read all the terms to see if the insurer doesn’t include coverage for previous conditions.
Failure to Follow Up with Treatments
When you are seeking medical care, following doctors’ orders is important. Whether you need to take a full course of medication or attend physical therapy, going against what the doctor orders can lead to a denial of your short-term disability claim.
Not Having a Qualifying Disability
Medical conditions, injuries, and illnesses must meet the definition of disability as defined by the insurer’s policy. If they do not, your claim will likely be denied.
Suspicion of a Fraudulent Claim
An insurance company will deny any short-term disability claim it believes is being made fraudulently. While you might have a legitimate claim, it is imperative that you provide all relevant information and documentation to prove your condition is real.
What to Do If Your Short-Term Disability Claim Is Denied
You may have a very painful injury that needs to heal or require surgery and rehabilitation. When your claim for short-term disability gets denied, it can be incredibly frustrating, but there are options to pursue.
Review Your Denial Letter
After calming down, take another look at the denial letter sent from the insurance company. It has to list the reason why your claim was denied. It may be something as simple as incomplete information or they may want more medical evidence first. When you know why your claim was denied, you can then figure out your next steps.
Gather Any Required Additional Information
For a number of applicants seeking short-term disability, the biggest reason for a denial is that information or evidence was missing. Gather what you need to help support your claim and submit it according to the insurer’s instructions.
Contact the Insurer
If you were denied for another reason or you’re not sure what additional medical evidence you need, contact the insurance company. You can discuss their decision and try to remedy the issue. Most likely, it will come down to sending them a few more things to prove your claim is legitimate.
File an Appeal for Your Disability Claim
You may find that by taking the steps above, your claim is approved and you can get the short-term disability coverage you need while you recover. However, if your claim is denied even after submitting additional medical evidence and documentation, it’s not the end of the line.
You can then file an appeal, which will usually involve submitting further documentation as well as detailing why you believe the denial was issued incorrectly. When you make an appeal for this type of claim, it is imperative that you follow the specific appeal process and deadlines set by the insurer, which is available in the policy. Make sure that you file your appeal within 180 days of receiving the denial letter.
An appeal may very well give you the desired results of an approval, though it can be long and complicated. Many people who deserve short-term disability often give up because of the stress and complexities involved, though they should be persistent.
Get Help From an Attorney
When you have a legitimate short-term disability claim and it is denied, it can be incredibly overwhelming. You need to be able to take care of yourself and have time to recover, and this coverage can reduce the burden of not being able to work in a short-term scenario.
If you have submitted enough evidence and meet all the eligibility requirements, yet are still being denied your claim, the best thing you can do is to turn to an attorney who specializes in disability insurance claims. They will be able to help you from the time you file your initial claim, or you can seek representation if you need to file an appeal.
An attorney can clearly explain your legal rights and options. They will fight to get what is fair for you when you deserve short-term disability coverage. Since your health requires care, don’t take on this type of stressful situation on your own. You’ll have an advocate who can speak to the insurer on your behalf to get your short-term coverage in place to alleviate your financial burdens.
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