Short-Term Disability Lawyers

While it’s obvious that a serious injury or medical issue comes with pain and mobility issues, most workers also understand that it can affect their ability to earn an income while they recover. While insurance can help you diagnose and treat your injury, it can also supply you with a percentage of your wages while you’re out of work, depending on your policy. Here, we review the basics of short-term disability, including how to file a claim and what to do if you’ve been denied coverage.

What Is Short-Term Disability?

Similar to workers’ compensation, short-term disability is a wage replacement benefit offered through an insurance policy. This is commonly through employer-sponsored insurance, but alternatively, it can be offered by state programs (depending on where you live) or purchased privately by the worker. 

Unlike workers’ compensation, though, the injury or medical condition does not have to be sustained while you were on the job. Rather, it covers between 40% and 70% of the wage you were making at the time of your injury until you begin work again.

How to Receive Short-Term Disability Benefits

Short-term disability can be a lifeline in the lives of those who have sustained a medical condition that will put them out of work for an extended period, but the process for receiving these benefits can be complicated. You’ll need to make sure that you have collected detailed documentation related to your claim and that you’ve filled out the paperwork accurately. Otherwise, you may risk having your claim denied.

Who Is Eligible for Short-Term Disability?

Not every worker will be eligible for short-term disability benefits, and the qualifying requirements may differ depending on where you live and your policy terms. In general, however, you’ll need to have been:

• Employed at the time of your injury
• Have worked for your current employer for at least three months (up to 12 months in some cases)
• Covered by a short-term disability policy
• Not receiving benefits through other avenues (such as workers’ compensation)

The injury or medical condition will also need to meet certain eligibility requirements. Most importantly, your sustained temporary disability must prevent you from being able to perform your typical job responsibilities for at least a few weeks up to a few months, depending on the terms of your policy. The condition must be severe enough to interfere with your ability to carry out the essential functions of your position, but not so long-lasting that it would fall under long-term disability or permanent disability classifications. 

Some examples may include:

• Recovery from surgery
• Severe illnesses (like pneumonia, cancer treatments, or heart conditions)
• Injuries from accidents that occur outside of work
• Pregnancy and postpartum recovery
• Debilitating mental health conditions (such as severe depression or anxiety)

Ultimately, whether your injury or illness qualifies for short-term disability benefits will depend on your insurance policy’s specific language. Before you file a claim, review your policy to determine whether or not you qualify. You may be able to do so on your insurance provider’s website or through your employer’s human resources department.

What Documents Are Needed?

The first step to filing a short-term disability claim is gathering medical documentation related to your claim. The goal is to show your insurance provider that your medical condition prevents you from working and that you meet the eligibility requirements listed above. Examples of documentation you may be able to submit include:

• Diagnoses
• Medical transcripts
• Medial assessments
• Prescriptions
• Letters from your employer and healthcare provider
• Paystubs

How to Apply for Short-Term Disability

Once you’ve collected your medical records and have notified your employer of your injury, the next step is to file an official claim. Contact your insurance provider to inform them that you would like to file a claim and request the necessary forms. Depending on your policy, you may also need to have your employer and medical provider fill out separate paperwork. 

After you’ve filed a claim, you should hear back from your insurance provider within a few days or weeks. In many cases, they will request more information regarding your medical condition or even request an independent medical examination. Regardless, it’s always a good idea to remember that any information that you offer them can be used to justify the denial of your claim.

If you feel this is happening, or that your insurance provider is avoiding communication, remember that a lawyer can handle communication with insurance or your employer while your claim is ongoing.

Common Reasons Short-Term Disability Is Denied

A denied short-term disability claim can be incredibly frustrating, but the good news is that with the right legal guidance, a denial is rarely permanent. Reasons your claim may have been denied include:

• Insufficient medical evidence
• Missed deadlines
• Pre-existing conditions
• Not following your doctor’s guidelines for recovery
• Disagreement between your insurance and your doctor
• Your condition or employment terms don’t meet the eligibility requirements

A short-term disability claim denial can often be reversed, but you will want to start this process as soon as possible, as you will have a limited amount of time to file an appeal. Start by reviewing your insurer’s appeal process and collecting more evidence if needed. This may entail getting another assessment or statements from your employer or doctor.

Do I Need a Lawyer for Short-Term Disability?

In many cases, yes. Building a disability case involves meticulous document collection and time-consuming paperwork, so many claimants find the benefits in hiring a lawyer to handle filing and communication with insurance while they recover from their condition. But beyond this, they also find that if their claim isn’t going the way they anticipated, a lawyer can often set things right again by collecting valuable evidence and advocating on their behalf. 

Short-term disability lawyers can also represent their clients during an appeal and use their experience and legal knowledge to point out flaws in the insurance company’s denial of their claim.

Have You Been Denied Short-Term Disability Coverage? Pond Lehocky Can Help

Regardless of what step in the short-term disability claims process you find yourself in, our firm is more than familiar with the many things that can go wrong. Pond Lehocky is proud to have provided over 15 years of legal service to workers struggling to get the benefits they are rightfully owed, and can anticipate any issues that may come up during the filing process and beyond. Contact us today for a free consultation to learn how we can get your claim back on track.