Everything about ERISA Disability claims is confusing for the claimant. In fact, many judges find this practice of law confusing as well. Your attorney’s responsibility is to help you understand how the claim process works because many of the ins-and-outs of ERISA disability seem counterintuitive.
When a client has been denied Short-Term Disability, they assume they can’t file for Long-Term Disability. In the normal world, this seems logical. After all, if the insurance company said you were not disabled in the short term, surely they’re not going to think you are disabled in the long term. However, this assumption can cost you.
Why Long-Term Disability Claims Are Really Denied
First, your disability claim is approved or denied based on the language in your policy, not your disability. Two people with the same job, illness, and medical history but different Long-Term Disability policies will have very different outcomes for their claim. The person with the better policy will likely have their claim approved while the other person will likely have their claim denied.
However, having a great Long-Term Disability policy won’t automatically guarantee your claim is approved. All insurance companies are concerned with profit, and if there is a way they can deny your claim, they will use it.
Your Short-Term Disability policy acts the same way. You are denied or approved based on the language in your policy.
You Can Be Denied for Short-Term Disability and Approved for Long-Term Disability
Your Short-Term Disability policy is different from your Long-Term Disability policy. In some cases, they are two separate policies funded by one insurance company.
In the case of Fairfax County Public Schools, teachers' Short-Term Disability policies are funded by the school board directly. This means your Short-Term Disability payments come directly from the school. But the decision about whether or not you are disabled is made by an insurance company working for FCPS.
In this case, the school board has a financial incentive to deny your Short-Term Disability claim. Often, these Short-Term Disability plans are written in such a way to make them confusing. There are short deadlines to file a claim and to submit medical records. They are usually reviewed and decided by an insurance company medical representative – who may or may not have any experience with your disabling condition.
Claims filed under these policies are sometimes denied for the smallest of reasons, hoping the claimant won’t pursue the claim further. If the insurance company denies the claim, their client is happy because their client doesn’t have to pay.
However, the Long-Term Disability plan is funded by an insurance company, not the school board. The policy is written differently, and Long-Term Disability claims are more likely to be approved. This is true for a couple reasons. First, Long-Term Disability claims generally receive a more thorough medical review by a doctor in the appropriate specialty. And second, the insurance company knows that if they wrongfully deny a claim, they – not their client – will get sued. It is entirely possible for a claimant’s Short-Term Disability benefits to be denied, and the Long-Term Disability benefits to be approved simultaneously.
Are You Allowed to File for Long-Term Disability Benefits After Short-Term Benefits Have Been Denied?
Your short-term benefits have been denied, this puts an automatic stop on filing for Long-Term Disability benefits… right? Wrong. You absolutely can file for Long-Term Disability benefits after your Short-Term Disability benefits have been denied.
Again, Short-Term and Long-Term Disability policies are two separate policies. They each have their own rules. Unless your Long-Term Disability policy bars you from filing your claim if your Short-Term Disability policy has been approved (most won’t), you can file for Long-Term Disability benefits even if your Short-Term Disability claim has been denied. Just check your policy for the Long-Term Disability “elimination period.” You must show that you were continuously disabled during the elimination period to be eligible for Long-Term Disability benefits – whether or not you were receiving Short-Term Disability benefits during that time.
In fact, getting approved for Long-Term Disability benefits will likely help your Short-Term Disability appeal. When appealing the decision of your Short-Term Disability benefits, your attorney can show that you have already been approved for Long-Term Disability benefits and use that to support your Short-Term Disability claim.
What Should You Do if You Have Been Denied Both Short-Term and Long-Term Disability Benefits?
If you have been denied for both Short-Term and Long-Term Disability benefits and your doctor believes you are too disabled to work, you need to contact an attorney. In some cases, your Long-Term Disability policy will deny you benefits because you have been denied Short-Term Disability benefits. Depending on your policy, you can appeal this decision.
As we mentioned above, this practice of law is confusing. Your claim has a better chance if you hire an experienced Short-Term and Long-Term Disability attorney to review your claim and help you navigate the difficult appeal process.