If you’re nearing the end of the coverage period for your short-term disability insurance—and you still can’t work—you might be expecting a smooth transition from short-term benefits to long-term benefits.
Unfortunately, it doesn’t always work that way—even if both policies are with the same insurance company and provided through your employer. Although your insurance company approved your short-term disability claim, that does not necessarily mean they will approve your long-term disability benefits. Far too often, claimants are blindsided by an unexpected loss of benefits and income after long-term disability coverage is denied.
To avoid a sudden loss of coverage, it’s important to understand the terms of your long-term disability policy and be ready to provide additional evidence if necessary.
In this blog post, we’ll take a closer look at some of the common pitfalls claimants experience when transitioning from short-term to long-term disability insurance. If you need help filing a claim or appealing an unfair denial, contact Bryant Legal Group today at 312-313-6179.
Understanding Short-Term Disability, Long-Term Disability, and How They Fit Together
Under normal circumstances, short-term disability coverage is meant to provide income replacement benefits to workers who are temporarily unable to perform their current job due to a medical condition or off-the-job injury. These benefits kick in after a short waiting period – sometimes as little as 5 or 7 days. Workers who contract an illness, are recovering from surgery, or are taking maternity leave might qualify for short-term disability benefits.
Long-term disability coverage is meant to provide income replacement for people who cannot work for an extended period due to illnesses, injuries, or disabilities that are often permanent. Depending on your policy, LTD benefits could be paid for a certain number of years or potentially until you reach retirement age. That said, they also have a much longer elimination period before benefits can begin. You usually need to wait at least 180 days, although some policies may have an even longer window.
If you know you’ll be unable to work for an extended period but are still within the elimination period, short-term disability benefits usually cover the gap. Employers will usually set the maximum short-term disability benefit duration to exactly match the long-term disability elimination period.
However, people run into problems when they assume that approval for short-term disability means that their long-term disability claim will be automatically approved as well. This is usually not the case, even if you have the same insurance company handling both the short and long-term disability claims.
- RELATED: Not Returning to Work After Short-Term Disability? What You Need to Know – Bryant Legal Group (bryantlg.com)
Common Reasons Long-Term Disability Coverage Is Lost or Denied After Short-Term Disability Runs Out
Insufficient Paperwork (and Higher Standard of Evidence)
If your STD and LTD policies are with different plan administrators, you’ll need to start completely over with a new claim. However, even if you have the same insurance company handling both your short-term and long-term disability benefits, you will likely still need to file additional paperwork.
This frequently goes beyond simply notifying your insurance company that you intend to file for long-term disability. LTD policies may include objective evidence requirements or other stricter proof of loss requirements for payment of benefits—meaning that the evidence you presented to be approved for STD benefits is no longer considered sufficient.
You may be required to undergo additional medical examinations. It’s also very likely that you’ll be working with a different department or case manager than you were for your short-term benefits.
Misaligned Benefit and Elimination Periods
In some cases, the benefits period for short-term disability runs out before you’ve reached the elimination period for long-term disability. This is most likely to occur if you’ve purchased disability insurance policies from separate companies on your own, rather than through an employer.
Other Challenges Claimants May Face When Transitioning to Long-Term Coverage
Lower Benefit Amounts
Depending on the terms of your policies, your monthly long-term disability benefit might be lower than your short-term disability benefit. For example, it’s not unusual for STD policies to pay up to 80 percent of your pre-injury salary, while most LTD policies average closer to 60 percent.
Changes in Continuity of Care
Depending on the terms of your policy, transitioning from STD to LTD may require you to change healthcare providers or receive additional medical evaluations. This can cause disruptions and anxiety, especially if you’re dealing with ongoing health issues.
Ongoing Evaluations and Surveillance
Once approved for LTD benefits, claimants may be subject to ongoing evaluations and surveillance by insurance companies. This can be invasive and stressful, as claimants may feel like they need to constantly prove their disability.
Vocational rehabilitation requirements
Some LTD policies require claimants to participate in vocational rehabilitation programs or demonstrate that they are actively seeking suitable employment. This can be challenging for individuals dealing with chronic or severe disabilities.
Tips that Can Help You Make a Smooth Transition to Long-Term Disability
No one wants to deal with an unexpected or unfair loss of coverage. While you can’t always control what an insurance company will or won’t do, you can take some proactive steps to increase your chances of getting your long-term disability claim approved.
The most important thing you can do is make sure you are still attending all your medical appointments and following your treatment plan. If you need to schedule time to see a specialist, don’t procrastinate. You need strong documentation and medical records to prove to the insurance company that you qualify for benefits. And if they find evidence that you aren’t following your doctor’s orders, they may deny your claim.
You should also notify your insurance company well in advance if you intend to make an LTD claim, particularly if a different company will handle it. The good news is that if the same company is handling your short-term benefits, they will probably send you forms ahead of time. However, don’t be afraid to ask your case manager and request them. Better to be safe than sorry.
- RELATED RESOURCE: Request Your Free eBook—Your Disability Insurance Claim Roadmap
Contact Chicago’s Premier Disability Attorneys Today
Most disability insurance policies are governed by a law known as ERISA, which sets strict deadlines and limitations for the appeals process. You may only have a short time to pull together medical records, doctor statements, and other materials into a comprehensive file for your administrative review. And if your appeal is denied, you won’t be able to add new evidence to your file if you decide to take your case to court.
It is therefore extremely wise to work with an experienced long-term disability attorney who can help you understand your policy and assemble the strongest possible appeal. You may have limited time and only one chance to get it right.
The disability lawyers at Bryant Legal Group have helped countless people successfully transition from short-term to long-term disability benefits, even in complex and difficult cases. We’d love the opportunity to review your case and determine what legal options might be available to you. You can reach us by calling 312-626-9316 or completing this brief online form.
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.