5 Reasons Short Term Disability Can Be Denied
There are several common reasons short term disability can be denied—including insufficient medical evidence, not meeting the definition of disability, the insurance company and their doctors believing that you can work, pre-existing medical conditions, and surveillance conducted by the insurance company.
As short term disability coverage is the first step in any claim (followed by long term disability coverage if you are not ready to return to work), it’s essential to understand why these short term disability denials happen.
Common reasons short term disability can be denied
Dealing with health issues is a challenge, and can be even more difficult if your insurance company denies your disability claim. On top of your health difficulties, medical treatments, and inability to work, the insurer that was supposed to be there for you has decided they will not pay your disability benefits. These corporate decisions can often be frustrating, not to mention poorly explained. In broad terms, there are five reasons short term disability can be denied:
Insufficient medical information
You do not meet the definition of disability
The insurance company, or their doctors, believe you can work
You have a pre-existing medical condition
Insurance company surveillance
1. Insufficient medical information
Many insurers use this widespread phrase as a common reason for denial. What they mean between the lines is that they don’t believe there is enough objective proof, medically, to justify your short term disability leave. Frequently, they will request detailed medical information as a follow-up to your diagnosis, which complicates the process and leads to a denied claim. The truth is this decision is complicated and, as such, should not be made by insurance company middlemen, but by doctors who understand your unique medical conditions.
2. You do not meet the definition of disability
The insurance company is deciding that they do not believe your disability is severe enough or is not considered a disability, and they feel you can still work.
These denied claims are pretty common with “invisible” medical conditions, like chronic pain, chronic fatigue, or mental illness. While this may sound like a final word on your disability claim, the insurer could be making a subjective decision to override your doctor’s medical expertise. If a doctor is supporting your disability claim and leave, then disability lawyers can absolutely help you challenge your denial.
3. The insurance company, or their doctors, believe you can work
The insurance company employs its own doctors, who may review your claim and decide there is insufficient medical evidence—or come to a decision counter to your doctor’s diagnosis altogether. Often these insurance company doctors only spend a cursory amount of time reviewing your disability claim. While medical treatment and opinions can differ, speaking to a doctor who knows you, knows your condition, and has your best interests in mind is crucial.
4. You have a pre-existing medical condition
This all-too-common reason short term disability can be denied means the insurance company isn’t even disputing that you are too sick to work—they merely believe the medical condition preventing you from working came into effect before your disability benefits and insurance coverage began. A pre-existing policy exclusion only applies early in your coverage—typically in the first year. This is a highly technical situation in which getting a lawyer to properly and thoroughly review your case and prior medical treatments is critical.
5. Insurance company surveillance
Insurers will often monitor your social media posts or hire private investigators to probe into your life and activities when you seek disability benefits. Often, the information they present to impugn your credibility isn’t even objective proof that you’ve been “caught in a lie”—merely that they have jumped to conclusions without full context and used that assumption to deny your short term benefits claim.
What to do when your short term disability claim is denied
There are many reasons short term disability can be denied, and the insurance company may cite more than one of them. While you’re entitled to an appeals process, navigating on your own can be very difficult. Your best bet for overcoming a short term disability denial, regardless of the reason, is to work with a disability law expert.
While having a disability claim denied can be profoundly discouraging, you are not alone. At Share Lawyers, we can help you navigate this difficult time and offer you the best possible disability support you deserve to receive the financial claims you are entitled to. Contact us for a free consultation.
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