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A short-term disability insurance plan can provide essential income to people who are left unable to work due to an injury or illness. While many people obtain these policies as a benefit of working for a generous employer, they often must still navigate a difficult path with the insurance company who oversees the policy.
In addition, these short-term benefit plans are usually subject to the federal law known as the Employee Retirement Income Security Act (ERISA). This law complicates any appeals processes and can significantly delay a policyholder’s attempts to get a court to intervene in a dispute.
Short-term disability insurance denials may seem like an inescapable end to your economic wellbeing. However, if you receive a denial letter after seeking disability benefits, you still have options. A knowledgeable insurance attorney could help you understand the reasons for your denial and pursue appropriate legal recourse.
A short-term disability insurance policy is much like any other insurance policy—in a nutshell, the insurance company agrees to pay benefits if a policyholder suffers a loss. However, one common dispute between companies and policyholders is whether a loss falls under the terms of an individual contract.
For example, short-term disability insurance plans only cover injuries that happen when an employee is not at work. Car accidents, serious illnesses, and even slips and falls can all qualify as grounds for benefit distribution under these plans. However, the insurance company may believe that an injury was the result of an employee doing their job. If so, it would be a matter for a workers’ compensation insurance claim to address.
Other examples of common disputes in short-term disability insurance denials include the following:
Any time an insurance company issues a denial, they must do so in writing with instructions on how to appeal that denial. Unfortunately, this appeal process can be very complex.
As discussed above, all insurance policies are contracts. Typically, a party to a contract may ask a court to intervene if they believe that the other party has failed to uphold their end of the bargain, and this is also true in short-term disability insurance disputes. However, the process to do so is complicated significantly by the Employee Retirement Income Security Act (ERISA).
ERISA is a federal law that regulates all employer-provided benefit plans. Because the vast majority of short-term disability benefit plan holders obtain these plans through work, ERISA typically governs the administration of these plans. This most directly effects policy holders when they need to appeal a denial.
ERISA states that all plan administrators must create an internal appeals process for handling disputes. In addition, a court may only hear a case alleging breach of insurance contract if a policy holder exhausts these procedures. As a result, a policyholder may need to wait many months after a short-term disability insurance denial before taking a case to court. Fortunately, an attorney may be able to help policyholders perform these inconvenient but necessary steps to protect their legal rights.
Receiving a denial following an application for short-term disability benefits can be incredibly demoralizing, especially if you need this money to cover vital expenses while you make a recovery from an illness or injury. Unfortunately, many insurance companies have a good-faith reason for issuing a denial and the legal remedy to protect your rights is complex.
If you have received short-term disability insurance denials, an insurance attorney could help you understand the stated reasons provided by the insurance company and explore your legal options. Many times, though, this will require a multi-step appeals process before asking a court to intervene, so getting in touch with legal counsel sooner rather than latter could allow them to more effectively work to protect your rights. Call today to learn more.
I want to say thanks to J. Price McNamara for the sound free advice he gave me related how to increase my chances of being approved for Long Term Disability of being denied. I must say after implementing elements of his sound advice such as showing the insurance company proof of how my illness/disability had
I needed an attorney with a specific specialty and Price McNamara was definitely the right choice. His representation was based on principles that are probably unsurpassed by any other attorney in the field. McNamara represents individuals, not big-money corporations, like so many others in his field of specialty. He is a consummate professional, extremely knowledgeable
I found Mr. McNamara to be practical and efficient. He did what I needed in a reasonable amount of time, keeping me well informed and with excellent results. He communicated with me clearly and on a timely basis. I will use him in the future.
I am a current client of Mr. McNamara’s. He is very accessible and responds to my emails and phone calls in a timely manner. I find him to be very professional and knowledgeable, as well as ready, willing and able to address all of my questions and/or concerns.
I am an attorney. Price represented me, and in a separate suit represented my daughter, for injuries. He moved the cases at lightning speed and obtained maximum recovery. I was grateful and surprised. I would recommend Price to anyone who wants a top-notch attorney who gets results.
I would recommend Mr. Mcnanmara to anyone at any time. He was the best attorney that my family and I came in contact with. About three years ago we had a very tragic, accidental death in our family and the company knew that it was their fault but of course tried passing the buck. Mr.
Price and Sara are great. They helped us in a time of need. Their communication was always spot on and I never felt out of the loop with what was going on with our case.
Price is very professional, honest, and reliable. Whatever he says, he will follow through with the utmost integrity. He will turn over every stone and pays close attention to even the smallest detail. I’m glad I secured his services.
Without going into the painful details regarding the reason for having to hire Price, his compassion and communication helped my family during an extremely difficult time. If you need legal help because you or a family member was injured by something or someone else, don’t hesitate to call him.
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