There is a difference between long term and short term disability.
Let's face it, nearly every aspect of ERISA Disability claims is geared to favor the disability insurance companies and difficult or confusing for the person with the serious injury or illness who is making the claim. Even many judges, lawyers and insurance people find this area of the law confusing. We try to cut through the confusion and help you understand the process of your disability claim and the law and what to expect.
When someone has an injury or illness and can't work, they often apply for Short-Term Disability. If they are denied these benefits, many people assume they can’t file for Long-Term Disability, or that the insurance company has denied that too. It seems to make sense, but that's not right. Here's why:
Why Long-Term Disability Claims Are Really Denied
Your disability claim is governed by the language of your specific disability policy, not whether you can work, or your diagnosis or injury, or whether you are disabled. That's why if two people with the same job, injury or illness, and medical history who have different Long-Term Disability policies, one can be approved for benefits and the other denied.
There are no guarantees when it comes to ERISA long term disability. All insurance companies operate for profit, and if there is a way they can deny your claim, and avoid paying you disability benefits, they will do it.
Your Short-Term Disability policy is no different in this regard. Your claim is approved or denied based on the language in the insurance policy.
You Can Be Denied Short-Term Disability But Still Approved for Long-Term Disability
Your Short-Term Disability policy is a different policy than your Long-Term Disability policy. Sometimes, they are two separate policies written by the same insurance company, so it can be confusing, but remember, it's the policy language that controls.
So if your Short-Term Disability Benefits Have Been Denied, can you file for Long Term Disability benefits?
Yes - a denial of short term disability benefits doesn't prevent you from applying for long term disability benefits.
Since they are two separate insurance policies, they each have their own definitions, requirements and rules. Unless the terms of your Long-Term Disability policy specifically prevent you you from filing a claim based on the determination of your claim for Short-Term Disability, you can file for Long-Term Disability benefits. But make sure to analyze the policy language an terms for the meaning of the “elimination period.” You will probably need to prove you were continuously disabled during the elimination period in order to be eligible for Long Term Disability benefits , but that applies whether you were receiving short term disability benefits or not.
Plus, being approved for Long-Term Disability benefits may 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 if both Your Short Term and Long Term Disability Benefits Claims Were Denied?
If you have a serious illness or injury and can't work, and your doctor indicates you can't return to work, but your claims for both short term and long term disability have been denied, you should contact a lawyer handling ERISA disability claims to determine how best to appeal, why you were denied and the evidence you will need to try to convince the insurance company that you are disabled under the policy.
Disabilty benefits law is complicated, especially when you're dealing with the effects of a serious injury or illness. So call us at (202) 393 - 3320 with your questions and we can help you take the next step.