How To Apply for Short-Term Disability

Quick Answer

The process for applying for short-term disability benefits is similar to that of applying for healthcare benefits, but it will differ depending on whether you receive them through workers’ comp, private insurance policies, state programs, or your employer.

Dealing with an injury or illness that prevents you from working can be a painful and frustrating experience. For many workers, one of the more stressful aspects of a short-term disability is going weeks or months without getting a paycheck or having their medical expenses covered. While some may qualify for workers’ comp, others may have to resort to their own insurance to address the financial hardship that comes with getting injured.

Here, our attorneys at Pond Lehocky will guide you through this process and highlight any potential issues that may come up and how we handle them.

Understanding Short-Term Disability Benefits

Short-term disability is an income replacement benefit that is usually part of an insurance policy. Claimants who receive short-term disability benefits typically receive between 50% to 70% of their salary while they recover to help them offset the financial hardship of being out of work. Short-term disability benefits may be offered through:

Workers’ compensation (if the injury is work-related)
The injured person’s personal insurance policy
Their employer-sponsored insurance policy
State programs (depending on the state)

How to Apply for Short-Term Disability

1. Determine Eligibility

Before starting the application, you’ll need to determine whether or not you are eligible for short-term disability in the first place. Generally speaking, at the time of your injury, you’ll need to have been:

Actively employed for at least 90 days (30 days in some states)
Have a medical condition that prevents you from working
Have a non-work-related injury (unless you are filing for workers’ comp)
Must be past your policy’s waiting period

2. Review Your Coverage

If you meet the eligibility requirements listed above, the next step is to determine whether or not your policy offers short-term disability. If your insurance is through your employer, your policy information may be available on employment posters or in your workplace handbook. You can also contact your place of employment’s human resources department for help locating your policy information.

If you have your own policy (whether private or through state programs), you can look at your policy’s portal or through the paperwork you signed when applying for your policy.

3. Gather Medical Documentation

Your insurance policy won’t simply take your claim at face value; you’ll need to compile documentation that supports your claim. If you haven’t done so already, see a medical professional for a medical evaluation as soon as possible and request a copy. This should highlight your diagnosis, treatment plan, functional limitations, and a statement given by your doctor that details your inability to work due to your condition.

Once you’ve been seen by a doctor, it’s also essential that you follow their instructions for recovery and attend all follow-up appointments. This will prevent your insurer from claiming that you caused your injury to become worse through inaction.

4. File Your Claim

Once you’ve followed the process outlined above, the final step is to file your claim. You must do this as soon as possible, as you may become ineligible for benefits if you do not file within 30 days.

Filing is slightly different depending on whether you’re applying through your employer’s insurance or your own. If you are filing through your employer’s insurance, you’ll need to request a claim form from your employer or HR department and have both your employer and doctor sign off on it. If you are filing through your own insurance or state program, you can contact your insurer’s claims department or potentially file online, depending on the insurer.

The Review Process

While the filing process is pretty straightforward, the review process can be somewhat intimidating. Once you’ve submitted your claim, your insurance provider will review your paperwork and will typically call you within a few weeks. During this call, they will typically ask you a series of questions about your injury or condition and your employment.

While the representative on the other line can seem friendly, remember that their job is to gather information that could be used to approve or deny your claim. Answer truthfully, but keep your responses clear and concise, and avoid speculating about your condition or recovery timeline. Instead, stick to the facts as documented by your doctor.

If you’re unsure about how to answer certain questions, it’s okay to tell them you’ll follow up after consulting with your physician or attorney. Within a few weeks, you should receive notification that your claim has either been approved or denied, or requires more information. If you do not hear from your insurance provider within that time, it’s a good idea to reach out again to check the status of your claim, as administrative issues are known to occur from time to time.

What Happens if my Short-Term Disability Claim Was Denied?

It can be incredibly disheartening to learn that your claim was denied, but keep in mind that initial denials are very common and are not always final. You also have the right to appeal the decision made by your insurer.

The first step to do this is to determine the reason your claim was denied. Typically, this is listed in your denial letter, but you can also contact your insurer directly. Some common reasons short-term disability claims are denied include:

Missing deadlines or incomplete paperwork
Insufficient medical evidence
Condition not covered under your policy
Disagreement over whether you are disabled

Next, collect additional documentation from your doctor that confirms your condition and your inability to work. In many cases, insurance providers need to see how your condition has progressed to make an accurate decision. Finally, submit a written appeal to your insurer as soon as possible.

Need Help Filing or Have a Denied Claim? Contact Us for Help

While you can certainly file or appeal a short-term disability claim on your own, many workers find that the process is much more streamlined with the help of an attorney. Doing so also typically yields better results, as they have legal knowledge that can help them determine any eligibility issues or bad faith judgments upfront. Regardless of where you are in the process, we encourage you to contact Pond Lehocky for a free consultation if you’re having issues getting the benefits you are rightfully owed.