Why was my short-term disability claim denied?

what to do when short-term disability is denied in OHYou opted into short-term disability insurance because you were worried about how bills would get paid if you could not work for several months. You thought you were doing the responsible thing to protect your family if an illness or injury prevented you from earning a paycheck. However, when the worst happened, and you had to make a claim, you were denied. How can this be?

It’s All in the Fine Print

Employers in Ohio aren't required to offer short-term disability policies to their employees, but some do. With this coverage, people unable to work for several weeks or months due to a non-work-related injury or illness can file a claim to recover some lost income and additional compensation while temporarily disabled. The conditions covered and the time you're insured depend on the terms of your specific policy.

Some short-term disability policies offer as little as 30 days, while others cover you for a year. However, no policy covers illness or injury caused by your job, because those circumstances fall under the umbrella of workers’ compensation.

Why Was Your Claim Denied?

Short-term disability claims are usually denied for one of these reasons:

  • The condition isn't covered. You have to understand the terms of your policy before you apply for benefits. Some policies cover time off for childbirth by C-section, for example, and others don't.
  • You didn't provide adequate medical evidence. Even though your disability is only expected to be temporary, you still have to provide medical proof that you're unable to work. If the insurer doesn't think the evidence is sufficient, it will deny the claim.
  • The insurer thinks you're lying. Insurance adjusters check out your social media, follow you around, and even talk to your friends and coworkers to find a reason to deny your claim. If they think your behavior contradicts your application for disability, they could deny it.

If you paid your premiums and are legitimately disabled, get the insurance benefits you deserve. If you're denied, you can file an appeal, but need the help of an attorney who handles these kinds of cases. Employer-sponsored benefits are governed by the Employee Retirement Income Security Act (ERISA) and are subject to strict regulations.

Contact Monast Law Office With Your ERISA Claim

As a dedicated workers' comp attorney for over 30 years, I'm honored to provide winning strategies for clients denied an employee benefit covered by ERISA, including short-term disability. Contact our office in Columbus to discover if we can help. To learn more about ERISA and the appeals process, request a free download of our book, Don’t Go It Alone: How Insurance Companies Sabotage Disability Claims. 

 

James Monast
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Fighting for Ohio’s Injured Workers and their Families