You filed your short-term disability claim and now you are playing the dreaded waiting game. You’re probably wondering, “how long will it take the insurance company to approve my short-term disability claim?”
The short answer is “check your policy.” Don’t have a copy? Ask your Human Resources representative. Most claims must be decided within 30-45 days, though in some cases the insurance company is allowed to take longer (for instance, if they are waiting for copies of your medical records or want to schedule an in-person examination).
The process can move quicker if you provide what the insurance company needs, when they need it. Frustrating as it can be, it is ultimately your responsibility to provide “proof of claim” to the insurance company. In practice, that means that if they don’t have copies of your medical records, even if they are the ones mishandling the request, they will deny your claim.
How Can You Speed Up the Approval Process?
The key is understanding that the insurance company needs to have two things:
- Your completed application for short-term disability (later, there will probably be a new, more detailed set of application forms for long term disability). The insurance company will give you forms to fill out and be sure to take your time with these. Be thorough – answer all questions. And be detailed about why you can’t work. This means describing both the limitations you now face and how they prevent you from doing your job.
- Medical support for your claim. The insurance company will never, ever take your word for it. In fact, your policy probably requires that you submit proof of claim from a doctor. This usually means submitting both medical records and an “attending physician’s statement,” which is a form your doctor fills out to describe your disability, your restrictions and limitations, your treatment plan and your return-to-work prognosis
Medical Records
It’s important to have strong, detailed records related to your disability. What is your diagnosis? What is your treatment plan? If the doctor has recommended that you stay out of work, make sure you ask for that statement in writing to add to your office visit notes.
It’s very important that your doctor describes your restrictions and limitations. Restrictions are things you cannot do, and limitations are things you should not do because they make your disability worse. The insurance company compares these restrictions and limitations to your required job duties to see if you can (or cannot) work within these boundaries.
There is no short cut. It is not enough for you or your doctor to say that you cannot work because of your disability. It may well be true, but it’s not enough to provide “proof of claim.” Proof of claim comes when the insurance company can have their medical reviewer look at your medical records and come to the same conclusion as your doctor. You need to paint them a picture of your situation so they can understand it fully.
cal reviewer look at your medical records and come to the same conclusion as your doctor. You need to paint them a picture of your situation so they can understand it fully.To do this, focus on highlighting your everyday occupational duties and explain in detail, with support from your medical records, why your disability is affecting your ability to work. For example, if you have a back injury and your duties require you to lift heavy objects, then you need to quantify both how much you are expected to lift at work and what your lifting restrictions from your doctor are. The insurance company needs to see that those two are not compatible.
Think of it this way. If the insurance company followed you around at work for a week, what would they see you doing and how would your disability affect that? Lay it out for them as best as you can.
Use Human Resources
It helps to maintain a good relationship with your employer’s HR department. They have forms to fill out, too, about your salary and job description. They can also give you a copy of your policy (which you should read cover-to-cover). Stay in contact with them during the claims process and ask them to intervene with the insurance company if you are having any trouble during the claims process.
Reach Out to An Experienced ERISA Disability Attorney
If you are unsure of how to approach the disability claims process, then please reach out to an experienced disability attorney for guidance.
We often see people make the big mistake of leaving their job position and then calling us for help in filing a short-term disability claim. Here is the problem with that. As much as we would love to help those people, the reality is that once you leave your job, your coverage under your policy ends. It becomes harder to prove that you were disabled while you were working and covered by your policy if you stopped working and waited to make a claim for disability benefits.
Sometimes disability claims are clear – we call these the “hit by a bus” claims. But often, disability comes on gradually. You could work with your condition then, but you can’t now. That’s complicated to explain. If this is you, the best time to call an experienced attorney is while you are still working. That way, we can guide you in the right direction and help you apply for short-term disability benefits. The last thing you want to do is ruin your short-term disability claim without fully understanding the process.
How BenGlassLaw Can Help with Your Claim for Disability Benefits
If you have not yet applied and are wondering whether you have a claim at all, we offer a flat-fee consultation to review your disability policy and your medical records, and discuss what proof you will need to provide of your disability. (If your claim is denied, and we do the appeal, we will apply your consultation fee to the appeal fee).
Takeaway
Filing for disability can be a stressful situation and you only have one shot to get it right. Give the insurance company what they need, when they need it, and you increase your chances that your claim will be approved quickly. They need proof of claim from you and your doctors, and while they may help request your medical records, ultimately it is your responsibility to make sure they get everything they need. No proof of claim = no disability benefits.
Disability = restrictions and limitations + required job duties. Make sure your doctor and your medical records document your restrictions and limitations and your employer documents your required job duties. Fill out your claim forms and paint a picture for the insurance company – why can’t you do your job?
If you have any questions, please give us a call at (703) 584-7277. We will give you our honest assessment and can schedule a flat-fee consultation if you would like us to review your policy and existing records and give you guidance on what could help strengthen your claim. And denial letter reviews are always free.
