If you’ve been denied short-term disability benefits, don’t panic. While receiving a denial can be disheartening and frustrating, it’s not the end of the road.
You can still appeal the decision and work towards getting the financial assistance you need. Here are some tips for writing an effective appeal.
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Understand the Reasons for Your Denial
The first step in writing an appeal letter is to understand why your application was denied. Most insurance companies will provide a written explanation for the denial, which should detail the specific reasons why your application was rejected.
Common reasons for denial include insufficient medical evidence, missed deadlines, and not meeting the definition of disability. Understanding why your application was denied can help you address those specific issues in your appeal.
Provide Additional Medical Evidence
If your denial was due to a lack of medical evidence, your appeal should focus on providing additional documentation that supports your disability claim.
This could include medical records, test results, and letters from your healthcare providers. Be sure to explain how your condition affects your ability to work and how it meets the definition of disability under your policy.
Follow the Appeal Process
Insurance companies typically have a specific process for appealing denied claims. Be sure to follow the instructions provided by your insurer, which may include submitting your appeal in writing, providing additional documentation, and requesting a review by an independent medical professional.
Make sure to keep copies of all documents you submit and follow up with your insurer to ensure that your appeal is being processed in a timely manner.
Short-Term Disability Appeal Letter Sample
[Your Name]
[Your Address]
[City, State ZIP Code]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Address]
[City, State ZIP Code]
Re: Appeal of Short-Term Disability Claim Denial
Dear Sir/Madam,
I am writing to appeal the denial of my short-term disability benefits. I recently received a denial letter dated [Date of Denial Letter] citing [Reason for Denial] as the reason for the decision. However, I strongly believe that I am entitled to these benefits and wish to appeal the decision.
I have been out of work since [Date you were unable to work] due to [Your medical condition]. My healthcare provider has diagnosed me with [Your diagnosis], which has rendered me unable to perform the essential duties of my job. I have attached a letter from my healthcare provider detailing my medical condition, treatment plan, and expected recovery time.
I also want to point out that I have been a loyal employee of [Employer’s name] for [Number of years] years and have never had any performance or attendance issues prior to my medical condition. I am committed to returning to work as soon as I am medically able to do so.
In light of these circumstances, I respectfully request that you reconsider my claim for short-term disability benefits. I am attaching additional medical documentation, including test results and progress notes, to support my claim. I am also willing to have an independent medical review conducted by a qualified physician of your choice.
Thank you for your time and attention to this matter. Please let me know if you require any additional information or documentation to support my appeal.
Sincerely,
[Your Name]
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