If I have been denied for short term disability, can I apply for Long Term Disability benefits?
It seems so routine that Insurance Companies will deny the last month or two weeks of Short Term Disability benefits even though there has been no significant improvement in the claimant’s condition. The reason they do this is that they are making a thinly veiled attempt to drag out the claims process. Let me explain.
If the focus remains on the Short Term claim, then the Long Term claim gets overlooked. The insurance company wants the claimant to go through the whole administrative appeal process which may take up to a year. In the meantime, no benefits are being paid and the Long Term claim has not commenced. If an effort is made to apply for the Long Term benefits in the meantime, the insurance company will contend that the claimant cannot do so because the entire period of Short Term benefits was not paid. This is an inaccurate statement of governing law.
When a client comes to me in this posture, in addition to proceeding with handling of the Short Term claim, the application for Long Term is also submitted along with a demand that it be handled in a manner consistent with governing federal regulation or, in the case of claims not governed by federal law (ERISA), with the ordinary claims process called for by law. Insurance companies resist this effort to every extent. However, if the Short Term denial is upheld and a lawsuit is necessary to enforce the benefit entitlement, the claimant needs to be in the posture of having the Long Term claim in place so it can be made part of that lawsuit. The claim for Long Term benefits must be pressed in the same time frames as the Short Term Disability claim this end.
Waiting on filing the Long Term claim until the Short Term claim is resolved will unnecessarily delay the claims process and, as a result, the securing of benefits. Do not allow the insurance company to refuse to process the claim for Long Term benefits. Sometimes, insurance companies will refuse even to produce the documents which need to be completed to perfect the Long Term claim. In that event, letters are submitted demanding that they do so and, if they do not, they are to consider the letter the application. Supporting medical documentation should be submitted therewith.
Please keep in mind that the foregoing is not intended as legal advice applicable to any individual person’s unique legal situation. Its sole purpose is to give a general idea of the existing status of the law as it applies to the point of law addressed above. You cannot rely on the foregoing as legal advice. You cannot make legal decisions based on its contents. If you have questions arising out of this point of law, you should contact an attorney who routinely handles claims involving policies of disability insurance. The law offices of Herbert M. Hill, P.A. handles such cases and would welcome the opportunity to discuss your case with you, at no charge. You can contact me at 407-839-0005 or at firstname.lastname@example.org.
If you would like, after discussing your case, we can set a conference. In most circumstances, that conference would be free of charge but in no circumstance would you be under any obligation to hire me nor would you feel any pressure from me to do so.
Herbert M. Hill, P.A. is a law firm located in Orlando, Florida with a practice extending throughout the state of Florida. While the vast majority of cases handled are for disability insurance benefits, areas of practice include employee benefit claims of all sorts. The firm handles any claims arising under the Employee Retirement Income Security Act (known and referred to as “ERISA”) for Denied Short Term Disability benefits, medical benefits, retirement benefits of any sort, including pension, 401k, termination agreements or the like as well as claims arising under private disability policies.