Denied Short-Term Disability? Follow This Appeal Checklist
No one wants to get a letter from the insurance company that contains a denial of short-term disability benefits. Unfortunately, it’s not a rare occurrence. Many people with legitimate disability insurance claims receive a denial and then have to appeal their insurer’s decision. If you’re thinking about filing an appeal with your short-term disability carrier, you need to have a plan — otherwise, you may make mistakes that reduce or eliminate your benefits.
If your short-term disability benefits are employer-funded, a federal law called ERISA (Employee Retirement Income Security Act of 1974) applies to your claim. This law sets out specific procedures that you must follow during your appeal. This article will focus on ERISA claims; if your short-term disability policy is private or self-funded, contact our office for help.
Step 1: Review Your Denial Letter
When the insurance adjuster denies your short-term disability claim, they must provide you with a detailed explanation for their decision. A simple “you’ve been denied” is insufficient under federal law.
Instead, your denial letter should outline:
- The specific reason why the adjuster denied your disability insurance claim, such as lack of supporting medical evidence
- Basic information about how to file an appeal
- Your appeal deadlines
This information is essential to your short-term disability appeal, since it will help you understand the issues with your claim as well as how much time you have to prepare an appeal. If you need any help understanding this information, contact a short-term disability lawyer right away.
RELATED: Disability Insurance in a Nutshell
Step 2: Understand Your Disability Insurance Policy’s Deadlines and Procedures
While your denial letter should outline the basic appeal deadlines and procedures that apply to your claim, you should also review your Plan Document or Summary Plan Description (SPD). These documents outline all the timelines, deadlines, and the precise procedures that you must follow during your claim.
Why should you spend so much time reviewing your short-term disability policy’s procedures? ERISA claims require a lot of attention to detail, and a simple mistake could cost you your disability insurance benefits. To reduce the risk of a mistake, you should carefully read these documents, identify all of the deadlines, and set reminders so you don’t miss a due date.
Unfortunately, many Plan Documents and SPDs are filled with dense legal language, which makes them hard for a non-lawyer to read and interpret. If you’re having a hard time understanding the precise terms and conditions of your disability plan, you should talk with an experienced disability lawyer. We can help you translate everything into plain language and suggest ways you can strengthen your claim.
Don’t put off your appeal; most short-term disability plans only give you 180 days to file an appeal and supplement your evidence.
Step 3: Schedule a Consultation With a Disability Lawyer
ERISA appeals are complicated and involve extremely strict procedures. While you can file an appeal on your own, it’s in your best interest to consult a lawyer. A short-term disability attorney can help you navigate your appeal and understand your legal arguments. During an initial consultation, you’ll meet with a lawyer who will review your documents, ask questions about your medical conditions and disability claim, and provide practical advice.
At Bryant Legal Group, we offer free, no-risk consultations, so there’s no reason why you should wait to talk with an experienced attorney from our team.
Step 4: Request Your Administrative Record and Supplement It
When you send the adjuster your medical records and other evidence, this information becomes part of your claim’s administrative record. This record is an essential part of your ERISA claim, because it is the only information that the adjuster or a federal judge can consider during your appeal. However, you only have a limited amount of time to submit additional evidence.
Once your insurance company-level appeal ends, your administrative record closes, and you cannot give the insurer or a federal judge additional information. So, during your initial appeal with the insurance company, you need to provide them with as much supporting evidence as possible.
Common forms of evidence in a short-term disability appeal include:
- Medical records from all your doctors, hospitals, and other medical providers
- Diagnostic reports, like MRIs, CT scans, EKGs, and sleep studies
- Mental health records from therapists, psychologists, and counselors
- A resumé that outlines your education, training, and work experience
- Your job description and other work-related information
- Letters from your doctors that carefully explain your limitations and ability to work
- Opinions from doctors, vocational experts, and other specialists
- Written statements about your symptoms and capabilities from either you or trusted loved ones
When you review your administrative record, look for missing information. Then, quickly request those records and send them to the insurance adjuster.
Step 5: Submit Your Written Appeal to the Insurance Company
When you want to appeal the insurance company’s denial, you typically need to do so in writing—a phone call isn’t enough. While you may send a simple letter that says, “I am appealing your decision,” that’s rarely sufficient. An experienced disability insurance lawyer can help you create a detailed appeal letter that outlines your factual and legal arguments.
Denied After Appealing to the Insurance Company? You Can Appeal Again
Even if you send the insurance company a well-written appeal letter and lots of new medical records, there’s a good chance they will still deny your appeal. Every day, insurers deny claims from people who are legitimately disabled. Fortunately, you have options even after an appeal denial.
When the insurance company denies an appeal, they must notify you in writing. Once you get their denial letter, you and your ERISA lawyer can file a federal lawsuit. While you cannot demand a jury trial, you will be able to present written arguments to a federal judge. In these arguments, you can explain your case and prove you’re eligible for short-term disability benefits.
Your ERISA Short-Term Disability Appeal Checklist
If you’re working with a disability insurance attorney, they will perform many of these tasks for you.
Review your denial letter. Identify the reason why the insurance company denied your claim.
Review your insurance policy’s appeal procedures and deadlines. Mark the filing deadlines in your calendar.
Consult a disability insurance lawyer who can educate you about your appeal options.
Request a copy of your administrative record from the insurance company.
Determine whether your administrative record is missing information about your medical conditions and disability claim.
Order the relevant records and provide them to the insurance company.
Write a detailed appeal letter and send it before your appeal deadline.
Review the insurance company’s final decision and assess your legal options.
Bryant Legal Group: Standing Up to Disability Insurance Companies
At Bryant Legal Group, we focus our practice on helping our clients with their disability benefits and other insurance claims. Our ERISA attorneys handle appeals at both the administrative and federal court levels, taking a practical, client-centered approach. If you have questions about an appeal, contact our office today.
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.