Disability insurance benefits — short-term and otherwise — are often denied by private insurance carriers, even when the benefits claim is legitimate and reasonably well-supported by the evidence. This can be quite confusing for first-time disability claimants who don’t fully understand why the application for benefits must be so comprehensive and why there is such a significant risk of the third party claim administrator or insurer choosing to deny a claim for such benefits. If you have questions or concerns, do not hesitate to contact Bryant Legal Group, P.C. today to speak with a Chicago short term disability insurance lawyer.
Third party claim administrators and insurers are fundamentally incentivized to deny claims that are not so comprehensive and obvious that a denial would simply be unjustifiable — and this is particularly true in the short-term disability context where the timeline for benefits is contracted and the claimant may be prioritizing their physical recovery over their benefits application.
Third party claim administrators and insurers often maximize their profits by denying short-term disability benefits claims. Suppose that an insurer denies six different benefits claims, and three of the claimants challenge the denial. In the subsequent disputes, only one claimant receives an award of benefits. Thus, rather than having to payout disability benefits to six claimants, the insurer only has to payout benefits to a single claimant.
This claim submission/denial dynamic should make it clear just how valuable a solid application for benefits really is — if you can apply for benefits with a comprehensive set of evidence that is sufficiently supportive of your claim, then you might be able to secure disability benefits in the “first round,” avoiding the hassle and cost of having to challenge the third party administrator or insurer’s decision to deny benefits.
Let’s take a look.
Submitting a Comprehensive Record of Your Disability
When submitting an application for benefits to the third party administrator or insurer, you’ll want to work with a Chicago short term disability insurance lawyer to identify and gather all the relevant evidence in support of your disability benefits claim. This evidence includes, but is not necessarily limited, to:
- Statements from healthcare providers
- Statements from co-workers
- Statements from your employer
- Statements from a vocational expert
- Income evidence (i.e., sales data, paystubs, etc.)
- Vocational records (i.e., negative performance reviews)
- Medical records
- Video footage
- Photographic evidence
- And more
Insurers must provide a justification for their denial, and commonly, insurers use “insufficient evidence” in the application for benefits as a justification for denying such benefits. By taking the time to investigate and include all relevant evidence, you can prevent the third party administrator or insurer from wrongfully denying your claim and further extending the process for securing your rightful short-term disability benefits.
Short Term Disability Issues to Consider
There are a number of issues that short-term disability claimants must consider before submitting their application for benefits. Failure to adequately consider these issues may lead to an automatic denial.
Minimum Waiting Period
You are not eligible to receive benefits until the waiting period has elapsed. The waiting period may last for a week or two, and up to a month or more (depending on the short term disability plan). Further, you may have to exhaust your remaining sick days to complete the process and become eligible or your sick time (or other accrued paid time off) may be used during the waiting period.
Many short term disability plans offered by an employer are considered payroll-practices and, although a third party may administer the benefits for your employer, these plans are frequently not provided through an insurance policy. This means that you have limited rights to an appeal or causes of action against your employer to challenge a denial.
Minimum Employment Duration
If your disability benefits are provided under an employer-sponsored plan, then there’s a good chance that your eligibility is further dependent on you having worked for the employer for a minimum period of time. For example, if you just started working a few days prior to submitting a claim for benefits, it’s possible that you will not meet the requirements for minimum employment duration and the claim will be denied.
Contact a Skilled Chicago Short Term Disability Insurance Lawyer for Assistance
Here at Bryant Legal Group, P.C., our disability insurance attorneys have extensive experience helping claimants apply for and secure their rightful benefits — whether their insurance plan is non-ERISA or ERISA-governed. If the claim is denied, delayed, or otherwise mishandled, we are more than capable of assisting you in putting forth a challenge and successfully navigating the internal review and civil litigation processes.
We are a results-oriented firm, and our thorough, aggressive approach to disability claims has brought us significant and favorable case results over the years — we have seen too many would-be benefits recipients give up on their claims prematurely, often bullied into submission by insurers who force them to jump through hoops. It is our genuine belief that by making an airtight application for benefits and pushing for a challenge in the event of an adverse decision, insurers will be pressured to give your claim its due consideration.
If you’d like to speak to an experienced Chicago short term disability insurance lawyer at Bryant Legal Group, P.C., please contact us at (312) 561-3010 or submit an online form through our website. We will evaluate your disability claim and work with you to develop a strategic map for the road ahead.