No, it is not.
Short-term disability benefits exist to support employees during difficult times. It offers financial relief to those whose health challenges prevent them from working.
Many people do get approved with a 30-40% approval rate annually. However, nearly 60% of the applicants face difficulty as the process is not straightforward. It includes problems, such as:
- Paperwork can be lengthy and confusing
- Medical documentation requirements may feel overwhelming
- Strict insurance rules can lead to delays or denials
All of this can add stress when your focus should be on recovery. This is where seeking the help of a short-term disability lawyer comes in. They have enough experience and specific knowledge that can help you secure your benefits. Meanwhile, you must be aware of the barriers preventing you from getting benefits and understand how to maximize your odds of success. Let’s dive in.
Common Barriers to Short-Term Disability Approval
1. Not Enough Medical Documentation
Insurance companies need detailed and consistent medical evidence that can support your claim. If you don’t have proper medical records, treatment notes, or test results, then it might lead to disapproval.
2. Not Able to Meet Policy Definition of Disability
Each insurer and policy defines “disability” differently. If your condition does not strictly meet their criteria, such as being unable to perform specific work functions, your claim may be rejected.
3. Unable to Follow Treatment
Insurers may consider your effort to recover as insufficient if you don’t follow your doctor’s prescribed treatment plan, including medications or therapies.
4. Missing or Incomplete Information
Mistakes in your application, incomplete paperwork, or missing deadlines can result in quick denial.
5. Lack of Disability According to Insurer’s Assessment
In some cases, the insurer’s medical examiners may disagree with your doctor about your ability to work. This leads to the denial of your claim even when your physician recommends short-term disability.
6. Ability to Delegate Duties
Some claims are denied if the insurer finds out you can perform alternative duties at your workplace or temporarily delegate tasks to others.
Tips for Improving Approval Chances
1. Gather Proper Medical Documentation
Make sure you have the following:
- Detailed doctor’s notes and diagnoses
- Treatment plans and records
- Statement on work restrictions
- Duration and prognosis
- Test results and imaging reports
- Attending physician statement (APS) ( it is submitted directly by your primary doctor or specialist, summarizing your current health, limitations, and need for disability benefits)
NOTE: Inform your healthcare providers early that you will be filing a disability claim and need detailed records.
2. Follow Prescribed Treatments
Take all prescribed medications exactly as directed by your physician. Attend all doctor appointments, therapy sessions, and rehabilitation treatments. Undergoing any tests or procedures recommended to monitor or improve your condition. Report any side effects or issues with your treatment to your healthcare provider immediately.
3. Review and Understand Your Policy
Each policy has its specific terms, conditions, and requirements that you must meet. Focus on areas in your policy, such as:
- Definition of disability
- Covered conditions and exclusions
- Benefit amount and duration
- Waiting period
- Claim filing deadlines
- Recertification and follow-up requirements
4. File Your Claim Promptly
- Notify your employer and insurance company immediately after your doctor confirms you are unable to work.
- Obtain and complete all necessary claim forms without delay.
- Attach all required medical documentation and doctor’s statements.
- Keep copies of everything you submit, including submission dates and confirmation receipts.
- Follow up with your employer and insurer to ensure the claim is progressing.
- Respond promptly to any requests for additional info or clarification.
5. Communicate Effectively With Your Doctor
Your doctor’s input is often the backbone of your claim. So, it is essential that they fully understand your condition and its impact of your work. Discuss with your doctor about:
- Your daily tasks, physical demands, and work environment.
- The impact on work due to your condition.
- Detailed notes, medical reports, and any statement required for your disability claim.
6. Stay In Touch With Your Employer and Insurer
It is important to connect with your employer and insurer. Make sure you:
- Inform your employer immediately.
- Share progress reports on your health.
- Address any requests from the insurer for additional medical records, forms, or clarification instantly.
- Document all phone calls, emails, and letters, noting dates, names, and subjects discussed.
7. Seek Legal or Expert Guidance If Denied
In case your claim is denied, then you can seek the help of a short-term disability lawyer. They:
- Understand your rights.
- Thoroughly review your denial letter and medical records to identify mistakes.
- Collect new or overlooked medical documentation.
- Prepare and file appeal paperwork precisely and on time.
The Bottom Line
You don’t have to get stressed about getting approved for short-term disability. By understanding common barriers and taking proactive steps, you can increase your chances of success and reap the benefits you deserve. With preparation, organization, and persistence, short-term disability can provide the financial support you need, allowing you to focus on recovery and return to work with peace of mind.
