If a person has a short term disability due to medical problems, an injury in an accident or other reason not related to their work, they are entitled to disability benefits from state governments and private insurers.
Short term disability is not a national program. These disabilities include giving birth, surgery and other things that would require rest and not allow the person to attend their job for a short time.
in order to get this benefit
In order to get this benefit, the person must be covered by an insurance company or have paid their taxes to the department in the state government that provides the service.
If the person applies in the correct way and is denied coverage, they may send a short term disability appeal letter to appeal the decision.
Disability Insurance From Employer?
If the disability insurance is from an employer and that employer is not a church or government agency, it is subject to the Employee Retirement Income Security Act (ERISA).
According to ERISA, the appeal of a denied disability claim must be made within 180 days of receiving the denial letter. If it is not appealed within this time, the person cannot sue the insurance company to get benefits.
Before drafting the letter, the claimant should read the letter of denial carefully and find out the steps required for appeal. There may be forms to fill out that need to be included with the letter.
They need to ascertain if the original application was faulty in any way. The claimant’s doctor can write a letter to be included in the appeal.
If there are medical records that relate to tests or treatment given after the claim was made, the claimant should request copies of them. This is more evidence of the disability.
Very Important To Enclose All Documents!
It is very important to enclose all documents and information that pertain to the case in the claims process and the appeal letter. If the appeal is denied, the person may sue the insurance company.
If this happens, any information used to make the case for the appeal must have been already submitted in the claim and subsequent appeal letter. If any information is left out such as hospital records or doctor’s records, it will not be allowed in court.
The law is heavily in favor of the insurance companies. To win short term disability benefits, the person must present a strong disability appeal that is supported by evidence. The letter can be short and simple.
It will not, in itself, change the decision of the insurance company. However, evidence will. All the information should be accurate and honest. Falsehoods will go against the claimant, even if they are unintended.
The letter should include:
- Identification of the claimant including case or member number
- The reason the claim was denied
- A short description of the disability
- A correction of any error in the original claim including incorrect file number, wrong document sent. The correction should be included along with a description of the error.
- A factual appraisal as to why the denial was wrong including medical evidence or doctor’s opinions.
- Explain the steps the insurance company or government agency should take and ask them to approve the application.
- Copies of the original application, the denial letter, medical documentation including letters from doctors.
Here is a sample letter for requesting an appeal for denied short term disability benefits. The letter should be sent by certified mail, so the sender has proof of the time and date the letter was sent and received. All enclosures should be copies of documents, and no original documents should be sent.
Sample Appeal Letter For Short Term Disability
900 Valley View
San Francisco, CA, 94104
May 03, 2021
ABC Insurance Company
4980 – 15th Street
San Francisco, CA, 94108
Dear Sir / Madam,
I am writing this letter to appeal your decision to deny me short term disability benefits. My case number is 09-0945-000. Enclosed is a copy of the denial letter, and, as you can see, the claim was denied because all of the medical documents were not included with the application.
I believe this is a wrong decision and have enclosed medical records to prove that I cannot attend work for six months. As it clearly states in the medical records and in the letters from my surgeon and physiotherapist, I have suffered two broken legs in an automobile accident, and the physiotherapist recommends six months of exercises to help me walk properly again.
I have enclosed all of my medical records with this letter including the subsequent report that states how long it will take me to fully recover. I would like you to reconsider my case and approve my short term disability claim as I have maintained my insurance premium payments regularly since I bought the policy on DATE.
If you have any questions or concerns, I can be reached at 585-123-4597 or at email@example.com. Thank you for your attention to this matter.
List of Enclosures