Reasons Short Term Disability Is Denied and What You Can Do About It
Disability benefits offer crucial support during times of illness or injury. To prevent interruptions to your benefits, you need to know the common reasons why short term disability claims are denied—such as insufficient medical evidence, not meeting the definition of disability, insurance company assessments, pre-existing conditions, or surveillance.
Need more information on why your short term disability was denied? Share Lawyers’ experienced team can help you understand your situation and provide a path forward.
Common Reasons Short Term Disability Can Be Denied
When battling your insurance company over the disability benefits you require to survive, it’s difficult to prioritize your health. Based on decades of experience in this area, we’ve identified the five most common reasons short term disability can be denied.
Insufficient Medical Information
What it means: They believe there isn’t enough objective medical evidence to justify 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.
You Do Not Meet the Definition of Disability
What it means: They believe you can work, either because your situation isn’t severe enough or your condition isn’t considered a disability.
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.
The Insurance Company, or its Doctors, Believe You Can Work
What it means: They believe you are able to 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, your condition, and your best interests is crucial.
You Have a Preexisting Condition
What it means: Your condition existed before your disability benefits and insurance coverage began, which disqualifies you for short term disability.
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.
Insurance Company Surveillance
What it means: Private investigators probe into your life and activities when you seek disability benefits.
Often, the information they present to question 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.
