If your claim for short-term disability benefits was denied, you might be wondering why. The insurance company always has to give you a reason in the denial letter. Sometimes the reason will be something they genuinely believe to be true about your claim. But, other times, they just need a reason to give.
In this article, I will explain some of the reasons you might see in your denial letter, and how you can move forward using those reasons to strengthen your case.
This article is a part of our Ultimate Guide to Short-term Disability Benefits.
Your symptoms aren’t serious enough to qualify for short-term disability
Your short-term disability may get denied because your symptoms don’t appear to be serious enough. This can be another way of saying that you don’t have enough medical documentation. Unfortunately, the insurance company needs more than just your own account of your symptoms. You might need to get extra confirmation from your doctor that your symptoms are serious, and how they prevent you from working.
Your medical records don’t show a serious disability
This is similar to the issue above. In this case, when the insurance company looks at your medical information, nothing indicates that you have a serious condition. This doesn’t mean that there’s nothing serious going on — it just means that your records don’t properly reflect it.
You will have to get more documentation from your medical team. Your doctor can further describe your symptoms and the treatment you require, for example.
Your treatment doesn’t indicate a serious disability
There’s a misconception that if you have a serious condition, you will receive serious treatment; the two always exist together. If the insurance company doesn’t see enough treatment or the right kind of treatment, they may provide this as a reason for your short-term disability to get denied.
Depending on your diagnosis, there are standards of practice in the medical community. You should be treated a certain way for a certain disease. The insurance companies will have doctors reviewing your treatments with these standards in mind.
The remedy? Make sure your doctor is following best practices and treating you accurately. This might mean you have to go see specialists and try medication to match the commonly perceived “seriousness” of your condition.
You’re not sick — you’re in a toxic work environment
The insurance company might give this reason, but what they really believe is that you don’t have a disability — it’s drama. You’re not sick, you just want to leave your toxic work environment.
Just because work stress has caused you to leave work doesn’t mean you shouldn’t qualify for disability.
When dealing with your insurance company, don’t overstate how bad your work environment is. If the insurance company can argue that the environment just needs to clear up and you’ll be fine, they will try to push that narrative. They will argue that there’s no treatment or sick leave necessary, the environment just needs to be fixed.
Obviously, this is highly oversimplified. In any case, you should bring up these problems with your employer to make sure they’re being corrected in the workplace.
Short-term disability does not cover parental leave
Sometimes, the insurance company believes that you just want to stay home with your kids. They won’t say this outright, but it may be heavily implied. If you’re off on sick leave and also happen to have young children, they might be skeptical about the truth of your claim.
This type of situation gets dicey fast. With these situations, we encourage you to get legal advice as soon as you can, as they are difficult to navigate. You have to be cautious of how you present yourself and careful with what you say when you interact with your insurance company.
Your doctor doesn’t support that you have a disability
Some doctors will fight for you. Sometimes doctors will be against their patients. For example, we’ve seen doctors write that they don’t think their patient has a disability. Or, they’re on the fence, and they simply aren’t saying enough in their records. They might include very general information — but not outright support.
If your short-term disability gets denied because of this, it’s one of the easiest things to fix. A lot of doctors have good intentions and are just mistaken about what’s required for you to go on sick leave. Sometimes, you will have to educate your doctor about what’s required and prove to them that you’ve done everything you can to get better. Once you have done this, their records should show their support.
Next Steps — Get Your Free Book
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