If you’re unable to work due to an injury, illness, or chronic medical condition, you may be eligible for short-term disability benefits. However, applying for disability insurance benefits isn’t as simple a process as you might imagine; it takes precision and a comprehensive legal strategy. Our ERISA lawyers at Bryant Legal Group are here to help.
In this article, our attorneys outline five ways you can improve your chances of getting your short-term disability approved.
How Does Short-Term Disability Work?
Short-term disability insurance is supposed to cover some of your lost income when you’re unable to work due to an injury, medical condition, or illness.
There are two primary types of short-term disability benefits:
- ERISA: Employer-funded short-term disability plans that are covered by a federal law, the Employee Retirement Income Security Act of 1974 (ERISA)
- Private insurance: Short-term disability coverage that you purchased yourself
While the claims procedures are somewhat different for ERISA and private disability insurance policies, you’ll always have to start your claim with an application for benefits.
Many people assume that their short-term disability application will be simple. However, the application process is typically more complicated than just filling out a form. Before you apply for benefits, we suggest you follow these steps.
1. Carefully Review Your Plan Document and Summary Plan Description
Every short-term disability plan has its own specific terms and conditions, which you must follow exactly. A single mistake or missed deadline can lead to lost benefits and a denied claim. So, before you start your short-term disability application, it’s best to review your policy’s rules and requirements, which are outlined in both the Plan Document and Summary Plan Description (SPD).
When you read your SPD or Plan Document, you should identify the following elements:
- How your plan defines disability: Do you have to prove that you’re unable to perform your current job, or does your plan require you to prove you can’t do any job within the national economy?
- Elimination period: A waiting period that you must complete before you can apply for short-term disability benefits
- Eligibility: Many ERISA short-term disability plans require that you’ve worked for your employer for a specific amount of time before you qualify for benefits.
- Pre-existing conditions: If you have a disabling pre-existing condition, check to see if there are additional waiting periods that apply to your claim.
- Exclusions: Some short-term disability plans do not cover certain conditions and procedures, like cosmetic surgeries that are not medically necessary and self-harm.
- Offsets: If you are receiving other benefits, like workers’ compensation, you may see a reduction in your overall compensation due to policy or statutory offsets.
Once you understand these factors, you can assess the strength of your claim and whether now is the right time to apply.
While you must understand your short-term disability plan’s rules, many people have a hard time understanding their Plan Document and SPD. If you need help translating these documents, you should contact an experienced disability attorney for assistance.
2. Be Honest About Your Health Issues and Limitations
When you apply for disability insurance benefits, the insurance adjuster will ask you about your health conditions and how they limit your ability to work. The adjuster will also want information about your job, education, training, and work experience. Your answers will help the insurance company understand your claim and assess your credibility.
If you report symptoms and struggles consistently to both your doctors and the insurance company, the adjuster will be more likely to believe you. However, if there are inconsistencies, the insurance company may deny your benefits or request surveillance from an investigator.
Very few people who file for short-term disability benefits are intentionally dishonest. Instead, people run into problems because they’ve minimized their symptoms when they talk to their doctors.
While it might feel easier to tell your doctor that you’re “doing okay” when you visit them, you’ll be better off in the long run if you give your doctor specific and detailed information about your day-to-day problems.
If your doctors truly understand your symptoms and limitations, they may be able to build a better treatment plan for you. Not only that, but your doctors will document your issues in their records, which will improve your credibility with the insurance company and strengthen your short-term disability claim.
- Related Article: How to Talk to Your Doctor About Disability
3. Get Organized and Collect Evidence That Supports Your Short-Term Disability Application
A successful short-term disability claim requires more than a completed application for benefits. You’ll need persuasive evidence that helps the insurance adjuster understand the severity of your conditions or injuries, assess your ability to work, and more.
While the insurance company may tell you that they’ll order all of the records for you, they may not follow through. We frequently see insurance company files that are missing hundreds or even thousands of pages of important medical evidence.
To build your claim, you’ll need to compile the following information and send copies to the insurance company.
- Medical records (i.e., treatment records, medical expenses)
- Vocational records (i.e., pay stubs, work scheduling)
- Work history information
- Functional and physical impairment forms
- Written statements from your treating physicians
- Written statements from your employer or colleagues about your ability to perform your job duties
- Assessment of career prospects by a vocational expert
- Proof of personal income
Every disability insurance plan is different, and some plans may require specific information that others do not.
Given the high-stakes nature of disability benefits and the likelihood that an insurer will use a “gap” in the record to justify a claim denial, it’s important to consult an attorney who understands how to build a comprehensive application for benefits.
4. Consult a Short-Term Disability Insurance Lawyer Early On
As you’re reading this list, you may feel overwhelmed. Both ERISA and private disability insurance claims are complicated, and many disabled people would rather focus on their physical healing process and emotional recovery rather than on meeting strict filing deadlines and interpreting their policy’s language.
We’ve found that the earlier you consult an experienced attorney, the better. Too often, we discover that people made honest mistakes that delayed their short-term disability claims or led to a denial of benefits.
In many cases, if these disability claimants worked with a disability insurance lawyer from day one, they would have avoided these unfortunate complications.
When you work with Bryant Legal Group, we take a hands-on approach from the very start. We’ll asses your claim, collect vital evidence, and negotiate with the insurance company on your behalf.
- Related Article: How Long Do I Have to Wait for a Disability Insurance Decision?
5. Don’t Take “No” for an Answer if You’re Denied
Insurance companies frequently deny both ERISA and private disability claims during the first round of the claim process, often relying on flimsy arguments. Insurers have an incentive to deny claims since many disabled individuals don’t even file an appeal. When you walk away from a legitimate short-term disability claim, you save the insurance company money.
Don’t assume that the company’s decision is correct. Instead, call your disability insurance lawyer as soon as you receive a notice that you’ve been denied benefits. Your attorney can help you understand your legal options and then craft a personalized appeal strategy for your claim.
Bryant Legal Group: Experienced and Respected Short-Term Disability Lawyers in Chicago
Bryant Legal Group is a Chicago-based insurance law firm that focuses on short-term disability and other complex insurance claims. Our attorneys have decades of experience litigating insurance disputes, and we have recovered millions for our clients through verdicts, settlements, and internal administrative resolutions.
Unlike many of our competitors, we work with staff medical experts and others to gather as much information as we can for our clients. This advantage helps guide our legal strategies and informs our understanding of each case.
Ready to speak with an experienced and skilled Chicago disability lawyer at no cost? Call 312-586-9650 or complete our online form to schedule your free initial consultation.