Common Reasons for Denial of Short-Term Disability Benefits

Oct 31, 2018 | Blog |

In the short-term disability insurance context, it’s rather common for disability claimants to feel as though their insurer is mishandling their claim — and this belief is certainly not formed without good reason.  Insurers are fundamentally incentivized to deny, delay, and otherwise mishandle short-term disability claims so that they don’t have to payout the benefits that you are rightfully owed.

Short-term disability claimants, generally speaking, are less likely to push forward and attempt to secure benefits when the insurer has denied a claim, as the claimant is likely attempting to recover as soon as possible from their condition and return to work.  It may seem as though it’s more trouble than its worth, and the prospect of benefits may seem uncertain.

With the assistance of a qualified attorney, however, short-term disability claimants can effectively challenge the wrongful denial of their benefits claim.

So, what tactics do disability insurers use?

Consider the following justifications commonly used by disability insurers to deny otherwise legitimate short-term disability claims.

Inconsistencies in Claimant Behavior and Statements

The insurer will use any inconsistent statements you make (in communications with their agents, for example) and any inconsistent behaviors you display to justify a denial of your disability claim.  In some cases, insurers will have employees track your social media profiles or conduct in-person surveillance to determine whether you are exaggerating your condition or otherwise misrepresenting the nature of your disabling condition.

For example, if you post on social media about your excitement to play in a soccer game on the weekend with friends, then the insurer will use that information to deny your disability claim (on the basis that your condition is not disabling).

Disability Insurance Application is Full of Misinformation or Lacks Information

If you have misrepresented certain material facts on your original disability insurance application, or if you failed to include relevant information that might have influenced whether the insurer would have sold you insurance coverage, then the insurer will argue that they are justified in denying benefits, as they can “rescind” coverage.

The key to challenging this sort of denial is in demonstrating that the lack of information (or the presence of inaccurate information) is actually immaterial to the insurance coverage.  For example, if you simply entered incorrect contact information, that would not be a misrepresentation that is material to your insurance coverage.

Insurer Determines That Your Disability is Only Partial

Many short-term disability insurance policies only payout benefits for total disability, and do not feature residual benefits for partial disabilities (i.e., conditions that interfere with some of the primary duties of your occupation, but not all).  Thus, short-term insurers may attempt to avoid having to payout benefits by evaluating your condition (in the context of your vocation) and determining that it may prevent you from engaging in certain duties, but that you are capable of performing at least some duties.

Delegation of Duties is a Possibility

The insurer may argue that you can simply delegate your duties to another employee for a temporary period of time, until your condition resolves.  Given the short-term nature of your disability, the insurer may argue that the delegation will not necessarily be disruptive to your career.

These are not winning arguments, however — arguably, the insurer could deny any disability claim (long term or short term) on the basis of being able to delegate certain duties to others.  Your ability to delegate certain duties cannot be used to justify a denial.

Claim Submission Lacks Necessary Evidence

When submitting a short-term disability benefits claim, you’ll want to ensure that your submission has all the relevant documentary evidence necessary to secure a favorable result from your insurer.  If your claim lacks supportive evidence — for example, if you forget to include statements from your treating physicians — then the insurer will use the insufficiency of your record to justify their denial.  For this reason, it can be beneficial to consult with an attorney early on, before any dispute has occurred.

Contact an Experienced Chicago Short Term Disability Attorney at Our Firm for Assistance

Here at Bryant Legal Group, P.C., our attorneys understand that short-term disability insurance claimants may find themselves in a uniquely vulnerable position.

Insurers are incentivized to take advantage of the situation and deny claims that might otherwise be legitimate, so long as the insurer can find the slightest reason to justify their denial.  We are committed to working tirelessly on your behalf to help you secure a favorable outcome, whether through negotiating an insurance benefits buyout, or through litigation.

Call (312) 561-3010 today to speak with an experienced Chicago short term disability attorney at Bryant Legal Group, P.C.  Consultation is free, confidential, and no-obligation.  We will evaluate your disability claims and help you develop an effective strategy for resolving your dispute.

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Please note: We are not accepting any new Social Security disability cases unless paired with a long term disability insurance claim or disability pension claim.

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