Millions of workers in the U.S. live paycheck to paycheck. Missing even a few days of work due to illness or injury can be financially devastating.
For many, short-term disability insurance is the only safety net available. Hiring a short-term disability lawyer in New Orleans to help you with the challenges of your claim is essential.
If your short-term disability claim has been denied, you may feel overwhelmed. A trusted New Orleans insurance claims lawyer can help you fight back. At ERISA Insurance Claim Attorneys, we’ve been helping clients get the benefits they deserve for over 30 years.
What is Short-Term Disability Insurance?
Short-term disability insurance provides income replacement when an illness or injury keeps you out of work. Unlike long-term disability, it covers a shorter duration, typically a few weeks to several months. It’s designed to help workers recover without losing financial stability.
This type of policy can be obtained individually or through an employer. Either way, benefits help cover living expenses during recovery.
For a free legal consultation with a short-term disability lawyer serving New Orleans, call (225) 201-8311
How to Get Short-Term Disability Coverage
There are several ways you can get short-term disability coverage. If you need help with your claim, don’t wait to talk to our skilled team.
Employer-Sponsored Plans
Many employers offer short-term disability insurance as part of their benefits package. Employees can enroll at hire or during open enrollment. Group plans often have lower premiums.
Individual Policies
Workers without employer options can purchase individual policies. These policies may offer broader customization but come with higher costs. Reviewing all terms before buying is crucial.
New Orleans Short-Term Disability Lawyer Near Me (225) 201-8311
Key Features of Short-Term Disability Insurance
Understanding how short-term disability policies work helps ensure proper use of benefits. Most plans include common components that affect coverage.
Premium
The premium is the cost of coverage paid monthly or annually. Employers may cover all or part of the premium. Individual policies require direct payment from the employee.
Benefit
This is the percentage of income you receive when unable to work. Most plans offer between 40% and 60% of gross weekly wages. These payments help cover essential expenses while you recover.
Benefit Period
The benefit period defines how long you can receive payments. Most short-term disability benefits last from three to twelve months. Once the benefit period ends, payments stop.
Elimination Period
Also called the waiting period, this is the time between the start of your disability and when benefits begin. It usually ranges from 7 to 30 days. You must be continuously disabled during this time.
Definition of Disability
Each policy includes a definition of what qualifies as a disability. This definition determines which conditions are covered. Always review it before filing a claim.
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Why Workers Choose Short-Term Disability Insurance
Short-term disability insurance is a popular option because of its flexibility. It covers a wide range of common conditions and pays benefits relatively quickly.
Broad Condition Coverage
Many policies include coverage for temporary health issues. These can range from injuries and surgeries to mental health concerns. The policy offers peace of mind during recovery.
Income Replacement
Policies typically replace a substantial portion of your wages. This support allows workers to heal without the stress of financial strain. Benefits begin shortly after the waiting period.
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Common Conditions Covered by Short-Term Disability
While each plan is different, most short-term disability policies cover a range of disabling medical conditions. Your eligibility will depend on your policy terms.
Examples of Covered Conditions
- Long COVID
- Mental health disorders
- Pregnancy and postpartum recovery
- Gastrointestinal disorders
- Post-surgical recovery
- Chronic back pain
- Vision impairment
- Neurological conditions
Filing for Short-Term Disability Benefits
To begin the claim process, you must first confirm that your condition qualifies. You’ll also need to meet specific employment and policy-related criteria.
Common Eligibility Requirements
- You’ve worked for the employer for a minimum period, such as 90 days
- You are a full-time employee
- You meet minimum wage or hour thresholds
Review your policy closely to avoid unnecessary denial.
Why Short-Term Disability Claims Get Denied
Unfortunately, insurance companies frequently deny claims. These denials often occur even when you meet eligibility criteria.
Pre-Existing Conditions and Incontestability
Policies may exclude coverage for pre-existing conditions. Insurers use “incontestability” clauses to deny benefits based on misstatements in your application. Even minor inconsistencies can be used against you.
“Active at Work” Clauses
Some policies require that you be actively working when the disability begins. Claims related to unscheduled absences may be denied. Exceptions exist for holidays or approved time off.
Missed Proof of Loss Deadlines
Insurers require proof of loss within a set timeframe. Generally, you must submit documentation within 30 to 90 days. Most policies allow up to one year from the date of disability.
Lack of Objective Medical Evidence
Insurers want hard evidence of your condition. This includes imaging, lab work, and clinical test results. A simple doctor’s note is often not enough.
Gaps in Medical Care
Insurers can deny your claim if you haven’t been under consistent medical care. This includes regular visits to a primary care physician or specialist. Continuing treatment is essential to support your claim.
What to Do After a Denial
Getting a denial letter doesn’t mean you’re out of options. Many denials can be successfully appealed with the right short-term disability lawyer in New Orleans.
Review the Denial Letter Carefully
The first step is to understand why your claim was denied. Some reasons are technical, while others are related to insufficient documentation. Knowing the exact issue is key to preparing a strong appeal.
Don’t Miss Your Appeal Deadline
For employer-sponsored policies governed by ERISA, you have 180 days to file an appeal. During this period, you must submit all evidence in what’s called your “administrative record.” Once this record closes, no new evidence can be added.
ERISA and the Appeals Process
If your policy is part of an employer benefit plan, it may fall under ERISA. These federal regulations outline specific appeal procedures and deadlines.
What ERISA Requires
Under ERISA, insurers must give you a fair chance to appeal. However, they also limit how and when evidence can be presented. That’s why it’s critical to get legal help before submitting your appeal.
Your Administrative Record Matters
Your administrative record is the only evidence the insurer or a judge will review. Anything not included will be ignored. Your attorney can help build the strongest possible record.
How a New Orleans Short-Term Disability Lawyer Helps
The appeal process can be complicated and time-sensitive. A lawyer’s guidance gives you the best chance of approval.
We Handle Appeals From Start to Finish
We analyze your denial letter, review your policy, and gather all necessary documentation. Then we prepare and submit your administrative appeal. Our experience with ERISA claims gives you an edge.
We Strengthen Your Case With Evidence
We gather medical records, expert reports, and witness statements. Our goal is to build a compelling, evidence-based case. A well-prepared record improves your odds of reversing the denial.
We Deal With the Insurance Company
Insurers are more cooperative when you have legal representation. We negotiate directly on your behalf and protect you from tactics designed to undermine your claim. You don’t have to face them alone.
Insurance Companies We Challenge
We’re not afraid to go up against major insurers. Our firm regularly handles claims involving large national insurance companies, standing firm to protect your rights and benefits. Insurance companies often have vast resources and legal teams dedicated to minimizing payouts or denying claims altogether.
That’s why having a knowledgeable and experienced legal team on your side is crucial. We know the tactics insurers use and are prepared to fight back aggressively to help you receive the benefits you deserve.
Companies We Take On
- Northwestern Mutual
- Aflac
- MetLife
- The Standard
- MassMutual
- Principal Financial Group
- Mutual of Omaha
- State Farm
No matter which insurer denies your claim, we can help. We have a strong track record of success challenging insurance companies of all sizes. We will thoroughly review your case, gather the necessary evidence, and advocate relentlessly to overturn wrongful denials.
When you face an insurance company, you need a law firm that’s ready to stand up for you every step of the way.
Additional Support for Disability Claims in New Orleans
We know how important it is to submit complete medical records and strong medical evidence. Many claims are denied due to missing documents, misunderstandings, or missed deadlines. We make sure your claim is handled carefully and thoroughly.
Our experienced team will guide you through every step. We also handle appeals under the Employee Retirement Income Security Act (ERISA). From filing to appeals, our experienced lawyers work to protect your rights and help you get the benefits you need.
Contact a New Orleans Short-Term Disability Attorney Today
A denied claim doesn’t mean you’ve reached the end of the road. Our short-term disability lawyers in New Orleans are ready to fight for the benefits you deserve. With over 30 years of success, ERISA Insurance Claim Attorneys is a name you can trust.
Call our office or submit your information online for a Free Denial Review. The sooner we start, the better your chances of approval. Visit our FAQ page to learn more.
Call or text (225) 201-8311 or complete a Free Case Evaluation form
