What Are Short-Term Disability Benefits?
If you suffer a minor injury like a broken ankle, contract a disease such as meningitis that might last for several weeks, or need to undergo a complicated surgery, and are unable to work, you may need to take time off work for treatment or recovery. Short-term disability benefits insurance is meant to help you in situations such as this.
If you find yourself in need of short-term disability assistance, many other Americans have been or are currently in your shoes. However, do not try to get those benefits alone before speaking to a dedicated attorney who is knowledgeable in Employee Retirement Income Security Act (ERISA) insurance coverage. If you are feeling uncertain about your future before you file a claim or after an insurance denial, an ERISA short-term disability attorney may be able to help.
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Why Might a Short-Term Disability Insurance Claim be Denied?
Many people pay premiums out of every paycheck for an ERISA-governed plan or pay a private insurance company for their coverage, even though they hope they will never really need it. If that time of need ever does come, having a short-term disability claim denied can be devastating.
Insurance companies governed by ERISA disability law often have a handful of common reasons for denying a short term disability claim. Some can be as simple as a clerical error or forgetting to provide a portion of a medical record, while others— such as alcohol consumption being related to the medical disability—can be more complicated to contest. Either way, an ERISA short-term disability insurance lawyer could work with a potential claimant to identify exactly what kind of coverage they need and help them establish viable proof that the coverage is necessary.
Short Term Disability Benefit Evidence Requirements
When it comes to disability claims, claimants should be prepared to provide an overabundance of medical records and doctors notes. An employee must provide clear and convincing evidence to the insurance company that they are physically unable to return to work and engage in any employment in order to receive benefits.
The insurance carrier relies upon these pieces of information to determine if the applicant truly has a medical disability. Without enough convincing evidence, the claim may be denied. An ERISA short-term disability insurance attorney may be able to help claimants gather all necessary evidence prior to submitting the application.
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Exclusions
Nearly all insurance policies list some exclusions or circumstances in which they would not pay on a claim. For instance, some companies would not provide coverage if the claimant sought previous medical care for the same or similar condition within a certain period of time.
However, as per LRS 22:215:15, if a master group life insurance policy was issued prior to January 1, 1993, the insurance carrier is prohibited from using a look back period of more than 12 months after the effective date of the individual’s coverage with respect to this reason for denial.
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Denials Based on Non-Compliance
Following instructions from medical professionals is not only important to a patient’s health—it can also be important to their insurance benefits. If a short-term disability applicant is found not to be in compliance with doctor’s orders or other advice from their own medical professionals, their disability coverage may be denied.
Some claimants falsely believe that no one will know if they are following their doctor’s orders or not. However, it is not uncommon for insurance companies to hire private investigators to find applicants out in public who are not in compliance with their own physician’s advice.
Get Assistance from an ERISA Short-Term Disability Lawyer
Consulting with a short-term disability lawyer regarding your medical condition and your disability coverage is a wise move if you were recently diagnosed with an injury or illness that could keep you off the clock at work for an extended period of time. Having professional legal counsel represent you from the beginning may increase your chances of approval for disability payments to prevent you from being denied unfairly.
The best time to contact an ERISA short-term disability insurance lawyer is usually prior to filing for insurance benefits. However, a legal team skilled in ERISA policies and procedures could work to help you no matter where you are in the short-term disability process. Call today to find out what an experienced disability attorney could do for you.
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