If I'm denied short term disability can I still get long term disability?

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That is a great question - and the answer is yes.

Short term disability benefits are different than long term disability insurance policies, so although you would think one automatically affects the other, it doesn't usually work that way. 

Even if the short term disability is denied, as long as you were covered under the long term policy, you can apply for and ultimately receive long term disability benefits.

This is the short answer, of course.  As with any long term disability claim under the federal law called ERISA, there are a number of steps you need to take to make sure you receive the benefits you deserve if you can't work due to a serious injury or illness.  

Make sure you request and analyze the long term disability insurance policy from your employer (or the insurance company directly if you have a private policy you purchased).  The terms and definitions in that policy will govern a lot of your actions going forward to make sure you qualify - and they could be different than the short term policy provides.

The key is usually that you have been disabled (as defined by the long term disability policy) during the time period covered by short term disability.  Usually this means you cannot work in your own occupation due to injury or illness, or sometimes that you cannot perform the "essential duties" of your job for a certain time period.  So as long as you were disabled as defined by the policy during the time you applied for short term disability, a denial of short term disability benefits won't affect your long term disability claim.  And the disability insurance company should have a different set of employees who review the long term disability claims as well.

Yes - it is the insurance company - Cigna, Reliance, Guardian, Unum, etc. - that both reviews and decides your claim and pays the benefits... a built in conflict of interest if there ever was one.

And if your claim is denied and you get a denial letter indicating why it was denied (and if it is an ERISA policy it should say you have 180 days to appeal), guess who decides that appeal?  The disability insurance company.  If your appeal is denied, you can file a lawsuit in federal court, but in almost every case, the federal judge will be deciding the case based on the record - which is your appeal.  There is a whole process for a long term disability appeal.

So your appeal is not just a form or a letter saying you disagree and are appealing - it needs to be compiled, analyzed and written as with a federal judge in mind, advancing all of the arguments and adding all of the evidence (not just a letter from your doctor saying you are disabled) you have or can generate - expert reports and evaluations, statements, interviews, etc. that support your claim.  

You don't get a second chance on that, so get the help you need early in the process.

If you received a denial letter, call us at (202) 393 - 3320 so we can arrange to review it for you, for free, no obligation.

Frank R. Kearney, Attorney-at-Law
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Experienced DC Workers' Comp, Long Term Disability & Accident Lawyer