Many employers offer short term disability benefits for their employees. Some employees in the Seattle area have their short-term disability through Prudential, Hartford, Lincoln, or Reliance Standard, among other companies. Sometimes, these companies are just the claim administrator and other times they are the payor or insurer as well as the claim administrator. Short-Term Disability seeks to give people the financial assistance they require when facing difficult situations like being in a car collision, suffering a fall, or getting surgery. Understanding the specifics of this coverage is crucial, though, since occasionally claim denials can leave policyholders feeling disappointed and confused about their financial future.
This article will explore the specifics of short-term disability, illuminate the typical causes of claim denial, and equip readers with the crucial knowledge to successfully manage this area of their insurance coverage.
Understanding Short-Term Disability Insurance
When a temporary disability prevents a person from working, short-term disability insurance from an insurer like Prudential or Lincoln can provide financial stability. To help the insured individual fulfill their financial commitments, the disability insurer or the employer provides a percentage of their income for a period, usually three to six months. There is a waiting period or elimination period before benefits kick in, usually one to two weeks, and the coverage’s maximum benefit term is typically three to six months.
The insured person must present medical evidence proving their impairment to be eligible for disability payments. Many companies like Prudential, Lincoln, Reliance Standard, Hartford offer coverage for a range of disabilities, including illnesses, accidents, and problems associated with pregnancy.
Understanding the coverage, exclusions, and restrictions of your short-term disability insurance policy is essential. Knowledge of the terms and conditions goes a long way to knowing what you need to provide to prove your case.
Reason Why Your Short-Term Disability Insurance Claim Could Have Been Denied
Insurers can deny claims for several reasons, such as:
- Lack of medical evidence: Insurance companies need medical evidence to back up disability claims. Your claim may be rejected if the supporting medical documentation is insufficient or does not fulfill the requirements of the policy.
- Excluded conditions: Some medical conditions may be excluded from coverage. However, insurance companies will often expand these terms beyond their reasonable meaning. Some short-term disability policies may exclude preexisting conditions.
- Failure to comply with policy conditions: To receive benefits, policyholders must comply with certain restrictions, such as waiting periods or minimum employment requirements or favorable employee reviews prior to making a claim. Claim denial may occur if these prerequisites are not met.
- Disagreements about the definition of disability: The insurer and the policyholder may have different ideas about what constitutes a disability, which might result in the denial of a claim. Or the insurance company may apply a wrong definition to your claim.
- Failure to timely provide information: Sometimes claims are denied because the insurance company alleges that you did not provide documents in a timely fashion. Always try and get your paperwork turned in promptly. Do not just rely upon the insurance company to make sure that your physicians fill out the forms.
When people with valid impairments are denied short term disability coverage, the stress and worry can add up quickly and hamper your recovery. In the context of tech workers, a wrongful denial of benefits might occur if a software engineer encounters a temporary impairment, such as a serious hand injury or a concussion that impacts their ability to concentrate. Often, short term disability claims are rejected for unjustified reasons because the short term disability carrier may also be the long term disability carrier and the company does not want to pay your claim for longer than a few weeks.
How An Attorney Experienced in Short Term Disability Can Help You.
The following steps are part of the basic process for submitting a disability claim to a company like Prudential, Reliance Standard, Lincoln Financial, or Hartford:
- Notification: Prior to filing a claim, the employee must notify the company of their claim. This can be done by getting in touch with your disability carrier directly or through the benefits division of your workplace.
- Claim forms: A company like Prudential will give the policyholder the required claim paperwork. These forms ask questions about your last day of work, your medical condition and/or medical procedures, the names of your healthcare providers, and other pertinent information related to your claim like your job duties and restrictions and limitations.
- Medical documentation: The burden of proving your disability claim is always on you. You should have a trusted person help you provide your medical records and evidence to the insurance company. Insurance companies will send you authorization forms to get records, but often they fail to get all the records or to get them in a timely fashion. It is important to make sure that the company has all your relevant medical records, test results, treatment plans, and remarks from your healthcare professionals.
- Review and assessment: The insurance company will hire a medical provider to review your records. Often these reviewers will reach out to your health care providers with questions. It is best if your providers ask the insurance company reviewers to submit their questions in writing so your providers can respond. Often the insurance company reviewers are not fair. They are biased to minimize your problems and complaints. Your medical professionals may have to push back against the record reviewer’s cherry picking of date, minimization of your symptoms, and sometimes outright errors made by the reviewer.
- Claim decisions: Once you receive a claim decision, it may have to be reviewed once a month or every other month. If your claim is denied, then you will have a limited time to appeal. If your claim is denied, you should hire an attorney because the stakes could be high, and it may be hard for you to figure out why the claim was denied.
Aaron Enge Law Has Years of Experience Dealing With Disability Insurance Claims
Aaron Engle Law has years of experience dealing with insurance company games, and we have a proven track record of by guiding policyholders throughout the disability claims procedure. We collaborate closely with clients to compile and arrange the required medical records and testimony, ensuring that the claim is presented truthfully and convincingly.
If you have had your disability claim denied, we can help you through the process. We carefully go through the rationale for the rejection, examine the provisions of the policy, and craft a compelling argument to prove your entitlement to benefits.
Why Work with Aaron Engle Law to Handle Your Short-Term Disability Case?
Aaron Engle Law is an ideal choice for those who have been denied disability benefits because of our proficiency in disability insurance law, individualized attention, and track record of accomplishment. AEL offers direction, assistance, and tenacious advocacy throughout the claims process. Clients may anticipate a results-driven strategy designed to get them the disability payments they should have been paid. When insureds work with Aaron Engle Law, they join a team that is committed to successfully navigating the complexity of disability insurance claims and working to maximize your financial and physical recovery.
Frequently Asked Questions About Short-Term Disability
Here are brief responses to frequently asked questions about short-term disability:
What compensation is available in a short-term insurance bad faith claim?
Most short-term disability claims are governed by ERISA that does not allow for state law bad faith claims. Also, many short-term disability claims may be self-funded and not really insurance at all. Some cases are governed by State law though, which does allow for traditional bad faith claims. For example, if you bought the policy from an agent yourself. If you made a claim under that kind of policy, if unreasonably denied, you could sue for bad faith. In Washington, you may be able to pursue extra-contractual relief under the Insurance Fair Conduct Act.
How to calculate short-term disability benefits?
To calculate short-term disability payments with a company like Prudential, you must know the percentage of your pre-disability income that is covered by the policy. The policy documents have information discussing the benefit percentage. Typical amounts covered by short term disability can range from fifty to one hundred percent of your pre-disability earnings.
How do I appeal a denial of my claim?
You should contact an attorney as soon as possible. The deadline for appealing a disability claim is often 180 days. Successfully putting together an appeal can take time, so it best to act quickly. The appeal process often entails getting further proof or data to back up your claim, responding to the record reviewer’s flawed opinions, getting testing, or speaking with your physicians. To successfully navigate the appeals process, it is advised to get legal counsel from an experienced attorney who focuses on disability insurance claims.
How Much Does It Cost to Hire a Short-Term Disability Attorney?
Every case is different, and the cost depends on what needs to be done to perfect your appeal. The first step is to get a copy of your claim file from the insurance company. The next step is a review of the file so that you can be given a detailed answer about how much the case will cost you to prove. During an initial meeting, Aaron Engle Law explains the costs and fees of a case.
By getting in touch with Aaron Engle Law, you can be certain that you’ll receive precise and individualized information on the expense of managing your Prudential short-term disability insurance claim.
Contact Us Today to Get Help with Your Prudential Disability Insurance Claim
In this post, we covered Prudential’s short-term disability insurance policy, the claims process, and some reasons for claim denials. We also discussed the benefits of working with Aaron Engle Law, who has focused on disability insurance claims for a long time.
They offer a track record of success, personalized attention, and expertise in disability insurance law. With their strong advocacy and assistance, they help clients navigate the complexities of the claims process and fight for the disability benefits they deserve.
If you’re dealing with a Prudential, Lincoln, Reliance Standard, Hartford or any other company short-term disability claim or facing a denial, contact Aaron Engle Law today to discuss your case and receive the necessary help. We defend your dignity and protect your piece of mind.