Millions of American workers are living from paycheck to paycheck. Many workers cannot afford to take off from work, even if the worker’s health is on the line. The lack of emergency savings and the physical demand of many positions can lead to workers being sick or injured over time.
When workers become sick or injured, they still need income to live. Workers who need to cover an illness or injury can take advantage of disability insurance. You need the experience of a trusted New Orleans short-term disability lawyer when your employer or their insurance company has denied your claim. Should your short-term disability claim turn into a long-term one, hiring an experienced lawyer today could save you many problems later on, as that process grows substantially more complicated.
Seek help from the experienced attorneys from J. Price McNamara ERISA Insurance Claim Attorney right away. The firm has been obtaining successful client outcomes for over 25 years, and we are ready to help you.
Table of Contents
- Short-term Disability Insurance
- How Employees Can Purchase Short-term Disability Insurance
- Short-term Disability Insurance Features
- Unique Benefits of Short-term Disability Insurance
- Insurance Companies that We are Not Afraid to Take on
- Contact a New Orleans ERISA Short-term Disability Insurance Attorney Today
Short-term Disability Insurance
Disability insurance is a common insurance policy that many employees purchase. This insurance policy provides coverage for injured workers when they must take time off from work due to an injury or illness. Disability insurance comes in two types of coverage: short-term and long-term. Short-term disability insurance is insurance coverage for workers who need to take time off of work for a certain amount of time.
How Employees Can Purchase Short-term Disability Insurance
Employees interested in purchasing short-term disability insurance can do so in two ways.
The first way is through their employer. Many employers offer disability insurance plans to their employees. Employees may either purchase individual or group plans.
Short-term Disability Insurance Features
Whether you decide to purchase individual or group coverage, some of the features that most short-term disability insurance policies have include:
- Premium. The premium is the amount that you or your employer pay for coverage. Depending on the terms of your policy, you can pay the premium monthly or annually.
- Benefit. The benefit is the amount of your income you will receive each month when you cannot work.
- Benefit period. The benefit period is the period that you can receive your benefits. You can receive short-term disability benefits from three months to one year
- Elimination period. Also referred to as a waiting period, an elimination period is how long your illness or injury must last before you can receive your benefits. The elimination period for a short-term disability policy can range from a week to 30 days.
- Definition of disability. Your short-term disability policy will contain a standard definition of disability that the insurance company will use to determine which conditions can qualify.
Unique Benefits of Short-term Disability Insurance
Between short-term and long-term disability insurance policies, short-term are some of the more purchased policies for employees. This is because the policy can cover many temporary medical conditions. The insurance policy will cover medical conditions like chronic back pain and ankle injuries and provide for additional rehabilitation benefits. Workers who have to undergo surgery or become pregnant can relax and feel confident in taking time off from work, knowing that their income is covered.
A Portion of Income that Short-term Disability Insurance Covers
One of the reasons why short-term disability insurance is so popular among workers is the amount of income the policy covers for the employee. Workers can receive at least 40 to 60 percent of their weekly gross income from their short-term disability policy. The benefits can kick in reasonably soon. Whether you suffer an injury for a few weeks or need to take a couple of months away from work, the insurance policy can still cover your financial expenses.
Common Medical Conditions Covered Through Short-term Disability Policies
Just like with any insurance policy, short-term disability policies do not cover every type of medical condition that employees have. While every short-term disability policy varies, many policies offer coverage for medical conditions preventing employees from working.
Some of the common medical conditions include:
- Long COVID
- Mental health disorders
- Pregnancies
- Gastrointestinal disorders
- Recovery after surgery
- Chronic back pain
- Vision loss
- Neurological disorders
Applying for Short-term Disability Benefits
When applying for short-term disability benefits, review your policy and ensure your medical condition qualifies under the policy's definition of disability. Depending on your short-term disability terms and requirements, you also want to meet specific criteria before filing.
Some of the general criteria that employees with a short-term disability policy must follow can include:
- Working for the employer for a certain amount of time. Some short-term disability policies prevent you from filing a claim if you have not worked for your employer for at least three months.
- A full-time worker status. Some short-term disability policies are not available to part-time workers.
- Meeting a minimum wage requirement.
What Happens After the Insurance Company Denies Your Disability Insurance Claim?
Even when you qualify for benefits and follow the mandatory instructions, insurance companies can still deny your short-term disability claim. There are several reasons why insurance companies can deny the approval of your disability claim:
Incontestability
Short-term disability policies do not provide coverage to employees who suffer from any pre-existing conditions. To prevent employees from receiving benefits, insurance companies will add "incontestability" provisions into their policies that allow them to deny coverage based on any misrepresentations in the application. That means the insurance company can use any contradicting information between your application and your claim as grounds for denial.
Failing to meet the actively-at-work requirement
Another common reason why insurance companies deny short-term disability claims is because of an “active at work” requirement. Many short-term disability policies require workers to be active at work during their disability. These disability policies also allow workers to continue to receive coverage even if the disability happened on a holiday or scheduled vacation. However, many disability policies do not allow workers to receive coverage when their disability happens on an unscheduled leave of absence. Insurance companies can use this reason to deny your claim unless the leave of absence was due to medical reasons.
Failing to submit a proof of loss
Another common reason is that a worker has failed to submit proof of loss within the designated deadline. When filing a short-term disability claim, applicants must submit proof of loss no later than one year from the time of the disability. The general time frame to send the proof of loss to the insurance company ranges from 30 to 90 days.
Failing to provide objective evidence
Insurance companies can deny your short-term disability claim when there is a lack of objective evidence included in your claim. The insurance company considers that objective evidence can vary, but general examples include laboratory test results, clinical results, and CT scans. You must include in your claim any evidence that can prove that there are legitimate limitations that can prevent you from working. It is not just enough for your physician to write a note declaring that you are unable to work.
Lack of proof that you are under the regular care of a physician
Suppose there is a lack of proof that you have been attending routine visits with a physician about your injury or illness. In that case, the insurance company can deny your short-term disability claim. Examples of proof include regular physician appointments or appointments with a specialist. Even if you are not satisfied with the medical treatment you are receiving, it will still be in your best interest to continue to see your physician or specialist or seek a new provider.
What is the Appeals Process?
When the insurance company denies your short-term disability claim, you may feel frustrated. It seems like the insurance company denied your claim with little to no credible evidence whatsoever. That is often the case with many applicants. Insurance companies can often cover your short-term disability benefits but still want to avoid paying out as many claims as possible. These companies issue denial letters because they want to discourage others from filing an appeal. However, you may appeal the insurance company's decision.
ERISA-covered Short-term Disability Policies
The route you have to take to appeal will depend on your disability insurance policy. For example, employer-sponsored short-term disability insurance may fall under the Employee Retirement Income Security Act (ERISA). ERISA laws help to cover the benefits of several types of insurance plans, from life insurance to disability.
Timeline to Submit Your Appeal
When ERISA covers your short-term disability insurance plan, you have 180 days to appeal the insurance company's decision. Within this period, you must submit critical evidence in what is known as your administrative record. This record will contain the only evidence they will consider in your appeal process. The insurance company will not consider any additional evidence not included in your administrative record when weighing the decision to overturn.
How Our New Orleans Short-term Disability Lawyers Can Help You
As you can see, the appeals process with an ERISA-covered disability insurance policy is strict. With the tight deadline and various evidence you must collect to give yourself a fighting chance in your appeal, you may overlook a crucial part of the process. Any mistake you make can affect your chances of having your denial overturned. With a qualified short-term disability lawyer on your side, you can alleviate a lot of the stress associated with the appeals process.
Filing an appeal on your behalf
An experienced short-term disability lawyer can help you before submitting your administrative appeal to the insurance company. A short-term disability lawyer can review your denial letter, assess and explain the insurance company’s reason for denying your claim and file your appeal on your behalf. An experienced short-term disability lawyer is familiar with ERISA procedures and the deadlines they must meet.
Gather the right evidence that can strengthen your case
Your administrative record will be the only time during the appeals process where you can submit new evidence that can convince an administrative judge to consider overturning your denial. Your short-term disability lawyer can assist with collecting and gathering the right balance of evidence to strengthen your case. In addition to your medical records, an experienced short-term disability lawyer can gather objective evidence, witness testimony, and medical notes that justify the limitations of your illness or injury.
Negotiate with the insurance company on your behalf
Insurance companies feel confident in their ability to intimidate a worker who only represents themselves. When a seasoned short-term disability lawyer is representing a client, the insurance company magically is more open to negotiating and coming to a compromise.
A seasoned short-term disability lawyer knows the tactics that insurance companies practice. Instead of keeping your guard and worrying about whether the insurance company will use your words against you, a short-term disability lawyer can advise you on the best ways to interact with the insurance company that favors you throughout the process.
Insurance Companies that We are Not Afraid to Take on
At J. Price McNamara ERISA Insurance Claim Attorney, our short-term disability lawyers set themselves apart from taking on insurance companies that other lawyers will not.
Some of the insurance companies that we are not afraid to take on include:
- Northwestern Mutual
- Aflac
- Met Life
- The Standard
- MassMutual
- Principal Financial Group
- Mutual of Omaha Bank
- State Farm
Contact a New Orleans ERISA Short-term Disability Insurance Attorney Today
When you want to give yourself the best chance of overturning your denial of your disability claim, speak to the short-term disability lawyers at J. Price McNamara ERISA Insurance Claim Attorney. Professional legal representation can increase your chances of getting the insurance company to approve your short-term disability claim.
Call our office at (504) 420-6962 or submit our contact form for your Free Denial Review. Do not let your employer and their insurance company deny your claim for any reason. Our New Orleans short-term disability lawyers are ready to fight for your rights.
New Orleans Office
829 Baronne Street
Suite 2B
New Orleans, LA 70113
Phone: (504) 420-6962
Fax: (225) 201-8313
(By Appointment)
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