3 Things You Need to Know About Short-Term Disability Denial
Apr 27, 2021 06:05 AM EDT
It's an exhausting feeling. After several doctor's consultations, days (even weeks) of missed work, and folders-worth of complex paperwork, you learn that the insurance company has denied your claims for short-term disability.
You know that you can't just head back to work. You have tried that, and your body has reached its critical limit. Yet, you also know that the insurance company won't give you your entitled disability benefits. So, you are stuck between the prospect of caring for your health and safety, and earning the money you need to stay afloat.
It's an immensely challenging position to be in - but there is help. In this post, let's explore a few things you should know about short-term disability denial. And if you choose to appeal the decision or sue (topics covered below), enlist the services of an employment lawyer to help win the claim.
You Need a Supportive, Thorough Doctor in Your Corner
A supportive, thorough doctor is key to your disability denial reversal. If your doctor is unsupportive, consider a second opinion.
For your part, be sure to follow the "appropriate or reasonable treatment" proposed by your doctor. You have to show that you are following reasonable treatment (although, precisely what this is can be ill-defined) as part of your disability claim. What this means, generally, is that the treatment relates to the condition for which you have made the claim. If you are confused by the parameters of "appropriate and reasonable" treatment, or believe the treatment you are receiving is not applicable, speak with an employment lawyer for help.
Finally, remember to keep all medical records (including receipts) and written statements given to you by your treating doctor.
You Have a Choice Between Appealing the Decision and Suing
You have a choice between appealing the denial decision or suing the insurer. An appeal is an internal process undertaken by the insurance company, whereas a lawsuit removes the decision-making potential from the insurer and puts it to a court to decide.
Occasionally, insurance companies do reverse their decision. Perhaps they weren't aware of a specialist you have been seeing, or some new test results you have received. These cases are relatively rare, but insurance companies are known to reverse decisions on occasion.
Suing an insurer requires time and resources, but it may be your best course of action. Ultimately, it's a decision that you should make with proper, professional counsel. As mentioned before, partner with a top employment lawyer, who will help you gather medical records and evidence in either case.
You Should Know Your Employment Rights
Can your employer legally dismiss you because of your disability? Do you have to return to work after a disability denial? Should you return to work after a denial? These questions may seem straightforward, but they require some parsing.
Firstly, no, an employer can't dismiss you because of your disability - that is discriminatory and therefore illegal. But they can legally terminate you if they can prove the dismissal is unrelated to the disability.
Secondly, you do not have to go back to work after a denial. A denial from an insurer does not mean you are able to work; employers cannot treat your non-attendance as unauthorized absenteeism if you have medical information stating that you have a disability precluding you from work.
Should you go to work, though? Ultimately, that is between you and your doctor, who will advise you of the potential harms. It isn't a bad idea to go back to work, if only to demonstrate that you are making an attempt. Trying and failing to resume work is a compelling argument for your disability claim.
If you have recently received a short-term disability denial, it pays to know your options and rights. Speak with a top employment lawyer as soon as possible to review your options and get started reversing the decision.