With the increase of work accidents in every occupation, you want to ensure you can receive as many benefits as possible following your injury. While workers’ compensation benefits are a viable option, the conditions of your injury or illness may require you to receive benefits as soon as possible. In addition to workers’ compensation benefits, you can take advantage of two types of disability insurance benefits: short-term and long-term.
If the injuries you sustain from work prevent you from temporarily performing your duties, short-term disability insurance is the right option. When you find yourself filing a claim for your short-term disability benefits, or if the insurance company denied your claim, the Houston short-term disability lawyers at J. Price McNamara ERISA Insurance Claim Attorney can assist you.
Table of Contents
- What is Disability Insurance?
- Short-term and Long-term Disability Insurance
- When do Short-term Disability Benefits Begin?
- How Does Short-term Disability Insurance Benefit Workers?
- How a Houston Short-term Disability Insurance Attorney Can Help
- Get Assistance from an ERISA Houston Short-term Disability Insurance Lawyer Today
What is Disability Insurance?
Disability insurance is a type of insurance policy that employers offer to employees. Its purpose is to replace a portion of the employee's income when they endured a severe injury or illness and can't work. One of the benefits of disability insurance is that the insurance company pays the employee's benefits directly to them, and there are little to no limitations on how the employee spends the money. Some policies can cover at least 70 percent of an employee's income, ranging from three months to the employee's retirement age.
Short-term and Long-term Disability Insurance
When it comes to the type of insurance policy that employees should select, employees can choose between short-term and long-term disability insurance. They offer different levels of coverage and lengths of the benefit period.
For example, short-term disability insurance covers an injured employee for a benefit period between three to twelve months. Long-term disability insurance can cover an injured employee from a benefit period ranging from five to 20 years or even until retirement age.
Like the benefit periods, the coverage levels between the two types of insurance vary. A short-term disability insurance policy can cover a substantial amount of an employee’s income, usually up to 70 percent. Long-term disability insurance can cover 40 percent to 70 percent of an employee’s income for a longer time.
When do Short-term Disability Benefits Begin?
It usually takes a few weeks following an illness or injury for short-term disability benefits to kick in. Short-term and long-term disability insurance policies contain what is known as an elimination period. The elimination period is the time an employee's injury must last before the benefits kick in.
A typical elimination period for short-term disability is 14 days, but it often ranges from seven to 30 days.
How Does Short-term Disability Insurance Benefits Workers?
Short-term disability insurance can protect workers from any financial hardships they may endure after suffering from an injury or illness. The benefits from this type of insurance policy can replace most or all of the employee’s income in the event of an injury.
Even though this type of insurance policy sounds similar to workers’ compensation insurance, workers have a better chance of receiving short-term disability benefits faster than workers’ compensation benefits. While workers’ compensation only provides coverage for workers who suffered an injury at the workplace, short-term disability insurance provides coverage to workers who suffered an injury outside of the workplace.
Qualifications for Short-term Disability Benefits
For employees to qualify for short-term disability benefits, a medical professional must deem them unable to perform their work duties. Several conditions can cause an employee to file for a short-term disability claim. Some conditions involve surgery, rehabilitation, pregnancy, mental illness, musculoskeletal conditions, and cancer. Any medical condition that affects a worker's ability to work for several weeks or months can qualify a worker for short-term disability benefits.
Exclusions to Short-term Disability Benefits
Even though people can cover most non-work-related medical conditions through short-term disability benefits, there are exclusions. Some common exclusions for short-term disability benefits include injuries caused by pre-existing conditions, self-inflicted injuries, injuries from an act of war or conflict, hazardous activities, and work-related conditions. Workers' compensation insurance can cover work-related injuries. Workers who file for short-term disability benefits cannot file for workers' compensation benefits simultaneously.
What Qualifies as a Pre-existing Condition?
When filing for short-term disability benefits, the insurance company will ask you to disclose all pre-existing conditions. The insurance company will use this information to form this policy. However, the insurance adjusters can also use this information for deceitful purposes. For example, insurance companies can insinuate that one of your pre-existing conditions caused your illness or injury.
How to Obtain Short-term Disability Insurance
There are several ways that you can obtain short-term disability insurance. One way is through your employer. Many employers offer short-term disability insurance at no cost to the employee or at a discounted group rate. This is true for employers in dangerous occupations with more prevalent physical injuries. For self-employed workers, individual short-term disability policies are also available. Workers who purchase short-term disability insurance can also purchase additional coverage from an individual policy.
Potential Issues with Short-term Disability Insurance
There are two critical periods when an insurance company can deny you short-term disability insurance as an employee. The first time is when you initially apply for short-term disability insurance. The second time is when you file a claim for your social disability insurance benefits. On both occasions, insurance companies can choose to deny your coverage for several reasons.
Reasons for Short-term Disability Insurance Claim Denials
Some of the common reasons for short-term disability insurance denials involve not covering the condition, failing to provide sufficient medical evidence, the nature of your injuries being questionable, or inaccurate or mistaken information in your claim.
Not covering the condition
The conditions that are covered in each short-term disability insurance vary. Some conditions are covered through the insurance policy, while others are not. It also does not help that the technical jargon in the insurance policy makes it difficult for you to understand what types of conditions are covered.
Failing to provide sufficient medical evidence
It is often easy for insurance companies to deny these types of claims because the injuries are temporary. If the insurance company does not believe that the evidence presented is credible, they will deny your claim.
The nature of your injuries is questionable
The insurance company can also deny your claim if the adjusters believe that your actions contradict the nature of your injury. Insurance adjusters often turn to an employee’s social media platforms and even resort to following employees around to find evidence that can question their injuries.
Inaccurate or mistaken information
Insurance companies can deny your claim if the claim contains any inaccurate information regarding the material facts on your original application.
Actions to Take after a short-term disability claim denial
When the insurance company has denied your short-term disability insurance claim, it is crucial to understand that you have the legal rights to appeal that decision. Your legal rights come under the federal law known as the Employee Retirement Income Security Act of 1974, or ERISA.
This federal law allows you to file an appeal for your short-term disability benefits by following several procedures. One of the procedures includes filing an appeal with the insurance company within 180 days of receiving your denial letter. Once you exhaust all of your appeal options, you may file a lawsuit against the insurance company.
ERISA Short-term Disability Benefit Lawsuit
Once your lawyer files your lawsuit, a judge, not a jury, will decide
the outcome of your short-term disability lawsuit. You cannot introduce new evidence into the lawsuit, so you must build a complete case in your administrative appeal. In any case, you will find yourself in a position where you have to act fast to present your case in the best way possible.
How a Houston Short-term Disability Insurance Attorney Can Help
From the time that you receive your denial letter from the insurance company, you may feel overwhelmed. You may find yourself in a position where you know you want to file an appeal but also want to give yourself the best opportunity to have your claim approved.
When you or a loved one find yourselves in this position, your best option is to contact a Houston short-term disability insurance lawyer at J. Price McNamara ERISA Insurance Claim Attorney. Our lawyers can help with your short-term disability claim appeal in several ways.
Create the best strategy for your appeal
One of the ways that our short-term disability insurance attorneys can help with your case is to design the best strategy for your appeal process. Our attorneys can help create a winning strategy by reviewing your denial letter and determining why the insurance company denied your claim. Insurance adjusters are required to provide a detailed explanation for your denial.
Review your short-term disability insurance policy
Another way that our short-term disability insurance lawyers can help is by reviewing the terms and policies of your policy. Because ERISA appeals require serious attention to detail, one simple mistake can cause you to lose your short-term disability benefits.
An experienced short-term disability insurance lawyer can carefully review all of your documents and ensure that you meet deadlines for your appeal. A short-term disability insurance lawyer can also clarify any confusing language in your policy and strengthen your appeal.
Offer practical advice
The short deadline to prepare the appeal can intimidate claimants. An experienced short-term disability insurance lawyer can help offer practical legal advice and assist you in presenting the best case for your appeal. Your short-term disability insurance lawyer can file paperwork on your behalf, gather and analyze the best evidence for your case, and keep in communication with the insurance company on your behalf.
Order the appropriate records and submit them to the insurance company
Another benefit of having a short-term disability insurance lawyer on your side is having someone who can order the proper records on your behalf. When submitting documents for your appeal, the information on each document will be the only information the judge will consider in the ultimate decision.
Because the documentation plays such a crucial role in your appeal, it will be in your best interest to have an experienced attorney submit the best documentation on your behalf. Short-term disability insurance lawyers are skilled in offering the proper evidence that presents the best case for their clients, including medical records from medical professionals and letters that explain your limitations and ability to work in detail.
Familiarity with the ERISA requirements
Having a short-term disability insurance lawyer familiar with the ERISA requirements can help strengthen your chances of receiving your desired outcome. An experienced attorney can ensure that your short-term disability appeal process is handled best during every step of the process.
One challenge ERISA requirements bring to a short-term disability benefits appeal is that the requirements tend to favor insurance companies. A short-term disability insurance lawyer with experience with ERISA requirements knows how to present your case in a manner that favors you over the insurance companies.
Get Assistance from an ERISA Houston Short-term Disability Insurance Lawyer Today
Regardless of where you are in your fight for your short-term disability benefits, an experienced ERISA short-term disability insurance lawyer can ensure that you have a fighting chance against the insurance companies. At J. Price McNamara ERISA Insurance Claim Attorney, our legal counsel is ready to represent you and increase your chances of succeeding in your appeal.
Our short-term disability insurance lawyers have experience presenting the best cases for our clients in a short window. Call our office at (713) 300-0462 or complete our contact form to find out what our skilled attorneys can do for you.
Houston Office
2000 Crawford St
Suite 1649
Houston, TX 77002
Phone: (713) 300-0462
Fax: (225) 201-8313 (By Appointment)
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