7 Reasons Short-Term Disability Can Be Denied and What To Do About It

Navigating the world of short-term disability and Social Security Disability Insurance (SSDI) benefits can be complex and daunting. Unfortunately, many applicants find themselves facing denials, leading to financial stress during challenging times. Understanding the eligibility requirements and common reasons for denial in both short-term disability and SSDI is crucial for ensuring your application stands the best chance of approval.

Common Reasons for Denial

1. Insufficient Medical Evidence: One of the most common reasons for denial is a lack of comprehensive medical documentation. Insurers require detailed reports from healthcare providers to substantiate your claim. Without adequate evidence of your condition and its impact on your daily activities, your application may be rejected.
2. Pre-existing Conditions: Many short-term disability policies have clauses that exclude coverage for pre-existing conditions. If your disability is linked to a medical issue you had before applying, the insurer might deny your claim, citing this exclusion.
3. Failure to Follow Treatment Plans: If you do not adhere to the prescribed treatment plan set by your healthcare provider, it can be viewed as a lack of effort to recover. Insurers may deny your claim based on non-compliance, arguing that your failure to follow medical advice affects your recovery.
4. Incomplete Application: Submitting an incomplete application can lead to immediate denial. Ensure that all required fields are filled out, and all necessary documents are attached before submission. Double-check your application for completeness.
5. Lack of Work History: If you have not worked enough hours or do not have a consistent work history, your eligibility for short-term disability may be in question. Insurers often require proof of sufficient employment and income before approving claims.
6. Employer Policy Restrictions: Different employers have various short-term disability policies, and some may have stricter criteria than others. It’s essential to understand your specific employer’s policy and its requirements to avoid pitfalls.
7. Delayed Filing: Most short-term disability policies have specific time frames within which you must file your claim after becoming disabled. Delaying your application beyond this period can lead to automatic denial.

What To Do If Your Claim Is Denied

If your short-term disability claim has been denied, don’t lose hope. Here are some steps you can take:

• Review the Denial Letter: Understand the reasons for denial to address any specific concerns.
• Gather Additional Documentation: If your application was denied due to insufficient evidence, gather more medical records and documentation to strengthen your case.
• Appeal the Decision: Most insurance companies allow for appeals. Follow the appeal process outlined in the denial letter, ensuring you meet all deadlines.
• Seek Professional Help: Navigating the appeals process can be challenging. Consulting with a legal professional experienced in disability claims can provide you with the guidance you need.

SSDI Does Not Cover Short-Term Disabilities

While many people think of Social Security Disability Insurance (SSDI) as a safety net for various disability situations, it’s important to understand that SSDI does not cover short-term disabilities. SSDI is designed for individuals with long-term or permanent disabilities that prevent them from working for at least one year or are expected to result in death. This means that if your condition is temporary, even if it temporarily prevents you from working, SSDI will not provide coverage. Instead, short-term disability insurance, often offered privately or through employer-sponsored plans, is intended for temporary disabilities. Understanding this distinction can help applicants focus on the right program to meet their needs and avoid denials based on eligibility criteria.

Why Hire Pena & Bromberg?

When facing the complexities of Social Security Disability Insurance (SSDI) claims, having expert support can make all the difference. At Pena & Bromberg, we focus on SSDI and understand the unique requirements and challenges of securing long-term disability benefits through this program. Our experienced team can help you determine SSDI eligibility, compile the necessary documentation, guide you through the appeals process, and represent your interests effectively.

We are committed to ensuring you receive the long-term disability benefits you deserve and will work diligently to support your claim every step of the way.

Conclusion

Applying for disability benefits can be a complex journey, especially when understanding the differences between short-term disability insurance and Social Security Disability Insurance (SSDI). Knowing why short-term disability claims are often denied—and recognizing that SSDI covers only long-term or permanent disabilities—can help you navigate the process more effectively and avoid preventable denials. If you’re dealing with the challenges of an SSDI application, Pena & Bromberg is here to support you with expertise and dedication, ensuring you have the best chance of securing the long-term disability benefits you need.