If you have a temporarily disabling injury, illness, or other condition, you may be entitled to receive benefits under your short-term disability plan. Even if you have a legitimate and well-supported benefits claim, it’s possible that the third party administrator or insurer will wrongfully deny your claim (or otherwise delay, redefine, undervalue, or mishandle your benefits claim). If the insurer has made a decision adverse to your interests, then it’s important that you consult a qualified attorney for guidance on how to proceed.
Short-term disability benefits coverage is rather unique, and many claimants are not fully aware of the specific limitations and issues associated with such coverage. For clarity, let’s take a look at some of the basics, first.
Basics of Short-Term Disability Coverage
Short-term disability benefits are a form of temporary wage replacement that are available to claimants who demonstrate that their condition imposes an impairment of such severity that they are incapable of performing the primary duties of their occupation for a period of time. The benefits payout may be calculated as a percentage of your total wages, or may simply be a specific, pre-negotiated amount paid on a weekly or bi-weekly basis.
Short-term disability benefits coverage may last for as little as a 30 days to as long as 26 weeks, after which point you will need to apply for long-term benefits (if you have a qualified plan and you are still suffering from the disabling condition at-issue). Some short-term and long-term policies are integrated, however, making it easier to transition coverage. If you’re confused about your coverage, a Chicago short term disability claim attorney can help you evaluate and understand the specifics.
Every plan is different, but generally speaking, short-term disability coverage requires a waiting period, full-time employment, and a minimum disability duration before the claimant is eligible to receive such benefits.
Unique Issues for Short-Term Disability Claims and Appeals
There are a number of issues unique to short-term disability coverage, denials, and subsequent appeals. Consider the following.
Mounting Pressure on the Claimant
Unlike long-term disability coverage, which can last for a lifetime (until retirement), short-term disability coverage is quite limited. Given that benefits are paid out for only a limited period of time (up to a year, in some plans), there is substantial pressure on the claimant to avoid committing too many resources — money, time, and effort — fighting the wrongful denial of their benefits. If the disability is severe but recoverable, the claimant may feel as though a better use of their limited resources would be to focus on resolving the disability and returning to work. This is particularly notable as — if the claimant were to return to work — they would almost certainly have no basis on which to challenge the denial of benefits (as the insurer would argue that the condition is not disabling if the claimant can simply return to work).
Temporary Disabilities Subject to Substantial Scrutiny
Temporary disabilities are subject to greater scrutiny as a general rule, given the fact that they are “limited” in time — there is an implicit understanding that the disabling condition will be resolved with adequate care and treatment (unless, of course, there is an integrated plan through which long-term disability benefits will be obtained later). Some short-term disability insurers require frequent medical updates so that they can keep apprised of the claimant’s condition and determine when exactly the disability has been sufficiently mitigated so as to reduce or eliminate benefits altogether.
Contact a Skilled Chicago Short Term Disability Claim Attorney for a Case Evaluation
Bryant Legal Group, P.C. is a boutique insurance litigation firm in Chicago. Our attorneys have decades of experience representing disability claimants in disputes with their insurance carriers and have assisted such claimants at every stage of the claim submission and litigation process, from gathering evidence to navigating administrative appeals procedures to resolving the conflict in a trial setting. This comprehensive, end-to-end approach to handling a disability dispute has brought us a great deal of success over the years, and we have secured many favorable case results on behalf of our clients.
We work closely with clients throughout the engagement to ensure that all relevant information is identified, gathered, and developed to the degree necessary to put forth a solid argument for benefits — we also utilize staff consulting physicians and other professionals to assist us with evaluating the disability itself.