Appealing a Denied Short-Term Disability Claim
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If you work in a state that requires short-term disability benefits, or you or your employer voluntarily purchased short-term disability insurance, you are entitled to collect benefits if you are temporarily unable to work due to an injury or illness that isn't work related. (Injuries or illnesses suffered on the job are generally covered through workers' compensation insurance, not short-term disability insurance.) Typically, you file a claim by completing a claim form, having your employer and your doctor complete their sections of the form, and submitting the material to the insurance carrier or state agency that administers the program.
But what if your claim for benefits is denied? In that case, you will have to learn the requirements for filing an appeal -- and follow them to the letter.
Step One: Learn the Rules and Deadlines
As soon as you learn your claim has been denied, find out how and when you must file an appeal. The insurance company may have included this information along with the letter denying your claim; if not, contact the company immediately and ask it to provide information on filing an appeal. There will be a deadline for filing the appeal, typically 60 days. If you miss the deadline, you will likely lose your right to contest the decision -- even if your short-term disability made it difficult to get things together in time.
Step Two: Find Out Why Your Claim Was Denied
The denial letter should give the insurance company's reason(s) for denying the claim. If not, contact the company immediately and request this information. If the company claims that you didn't follow the proper procedures or submit the right paperwork for filing a claim, review your claim form to see whether the company is correct.
Step Three: Collect Evidence to Support Your Claim
Depending on why the company denied your claim, you may want to gather documentation from your doctor, a second opinion, written observations by coworkers or others about your injury or illness, and any other written proof that you are entitled to benefits. For example, if you were in a car accident, you might want to submit the police report and written records from emergency room staff who treated you.
Step Four: Submit Your Appeal
Follow the insurance company's rules to the letter in filing your appeal. You may need to write a statement explaining why you believe you are entitled to benefits. You may need to resubmit your original claim, file another report from your doctor, or provide other information. Make sure you follow all applicable procedures, so your appeal won't be denied on a technicality.
If you need help preparing your appeal, consider talking to an attorney. An attorney can help you assess your situation and provide all of the necessary evidence for your appeal.