Top 13 Q & A about Short-term Disability Denial
With over three decades of experience, Share Lawyers specializes in Disability Insurance Law. We have helped thousands of clients take on insurance companies to get the short-term disability benefits that they deserve. Applying for short term disability benefits can be an extensive and complicated process, and unfortunately it can often end in a denial from the insurance company. If you are denied – do not give up! Disability lawyers are best suited to help you navigate your next steps.
We wanted to compile a helpful guide of some of the most frequently asked questions we get about short term disability and about short term disability benefits denial. We hope that these are helpful, and we will always welcome your call if you want to ask further about your potential case.
- What constitutes short term disability?
A: Short term disability is really exactly that – think about an injury, illness, or hospitalization that renders you disabled, but only for a limited period of time. Short term disability can cover you for up to 26 weeks depending on your employer’s benefit plan. This can include a brief illness, where your doctor assesses that you will need several weeks to recover, or a rest period that your doctor orders after surgery. Just because it is ‘short term’ this does not mean that your illness or injury is any less serious than if it were long-term. In this case though the prognosis is that you will be able to return to work before too long.
- When do I need to apply for these benefits?
A: Your benefits provider is able to offer you the necessary forms that you will need to complete in order to apply. You will require documentation from your physician, which outlines the nature and the extent of your disability. You will also need a statement from your employer that confirms your employment details such as your role in the company, the nature of your work, your salary, duties and responsibilities, etc. Lastly you will also need to submit your own statement as a claimant speaking about the nature of your illness or injury and any other claim information that they ask for.
One of the best attributes of STD benefits is the short waiting period. If you are hospitalized, your coverage may start from the day of your hospitalization. If you are otherwise suffering from an illness, there may be a delay of about one week before coverage kicks in.
- Am I eligible for EI sick benefits while I am collecting STD?
A: There is often a great deal of confusion about the overlap between employment insurance (EI) and short term disability (STD) benefits, and when a person with a short term disability should claim one or the other. Both are intended to provide you coverage during an illness or injury while you recover. Clients will often wonder why they should go through the process of applying for STD benefits if they can receive money under EI instead?
Collecting EI during a short illness is usually an easier application process. EI will supply you with coverage at your doctor’s word – they will not do any intense probing in an attempt to deny you benefits. However the coverage is generally 10-25% less of your regular pay that you would receive under STD benefits. Also EI benefits are taxable, whereas your STD benefits
- Why did my short term disability claim get denied?
A: There is no one singular answer to this. The truth is that your claim may have been denied for any number of reasons. Remember – your insurance company’s goal is not to pay you benefits! They will seek to deny you if they feel that they have the opportunity, so they may find something within your documentation that they feel gives them a window, or they may assess your situation differently.
Just because you were denied, it does not make your illness any less real or less serious. There are other options available to you, such as appealing the denial with a disability lawyer, filing a legal claim, or pursuing an application for long term disability. Do not give up hope just because you received a denial from your first attempt at a claim!
- Should I go back to work if my STD claim is denied?
A: This is not always an easy question to answer. If your insurance claim was denied, it likely means that your insurance company did not believe that you were sick enough to not be working. While they are often incorrect, they may not be in every case.
Some claimants will choose to go back to work after a denial. The benefits denial will cause them to take a step back and reassess the situation, and they may decide not to bother trying to re-apply. Others may try to go back to work only to realize that they are absolutely not well enough to be working, and if they reapply after leaving again then the insurance company may then reevaluate knowing that you made your best efforts to go back.
Most importantly though is that you know your own body. If your disability claim has been denied and you know you are not well enough to go back to work, contact a disability lawyer to assess your options.
- Am I not sick enough to be receiving STD benefits?
A: Not necessarily! In our decades of experience practising disability law, most of the denials that we see are incorrect, and the claimants have solid grounds for an appeal or for a legal claim. The insurance company’s goal is not to pay out your benefits – that’s not how they make money! Their job is to make it as difficult as possible for you to receive benefits!
If your benefits claim is denied, consult with a disability lawyer to discuss how to get past your benefit denials. It may be a matter of simply applying again, or there may be potential grounds for a legal claim.
- Can my employer fire me because I am sick?
A: The short answer is ‘no,’ but unfortunately this does happen. In Ontario almost any employee can be let go at any time for any reason, so long as they are given notice, or paid out instead of this notice. One of the only reasons that it is not legal to terminate someone’s employment is if it is because of a protected human rights ground, such as the person’s age, their race, their religion, or if they have a disability for example.
If your employer fires you because you are sick, they may be committing a serious violation of human rights law. There are some significant legal protections in place to prevent this, and employers may be liable for some serious penalties under human rights law. Employers may try to defend this as a business move, saying that they had legitimate business reasons, but a lawyer may be able to help you make a strong case. We do not practice employment law but would be glad to connect you with an employment lawyer who would be best able to help.
- Can my employer terminate me if I am on short term disability?
A: The answer is likely not. Again, an employer cannot legally end your employment because of your disability, and they can be punished severely for doing so. If your employer ends your employment while you are on short-term disability, it would be hard for them to prove that the two were not connected, and that you were not fired because of your illness.
There may be some exceptions to this, such as if the business significantly changes or closes during your absence, however these are technical circumstances that would require the advice of an employment lawyer. We would be pleased to connect you with an employment lawyer who can advise as to the employment aspects of your file while we handle any of the disability-related items.
- Will depression or anxiety mean that I cannot receive benefits?
A: This is absolutely untrue! There is an old stigma that still exists that suggests those with mental health issues are unable to receive benefits, or that claimants will be denied benefits because their illness relates to mental health. We have come a long way in recent years in recognizing and accepting that mental health illnesses such as depression and anxiety are just as ‘real’ as physical illnesses and deserve to be treated the same way.
If your illness is related to a mental health episode, make sure that you have the appropriate documentation from your physician outlining your illness and how it impacts your overall health. Your application for benefits may be denied, but a disability lawyer can help you build the right case to maximize your chances for success.
- What happens next if my short term disability claim is denied?
A: If your short term disability claim is denied, the most important thing to remember is not to give up hope! Your insurance company has probably already put you through the wringer at a time when you are unwell or trying to focus on your recovery. There may be back and forth of telephone calls and voicemails, where they have asked you to repeatedly send in a form that you already have confirmation of them receiving. As hard as it may be, do not get discouraged!
If you are denied, you have a few options available to you. One is to walk away from the process and try to go back to work, but this is rarely advisable. You are the best judge of your own health, and you know if you are not well enough to press on and go back to work. You could try to do battle with the insurance company yourself and appeal their decision, but we always suggest a call to a disability lawyer. Our disability lawyers will take your call for free, and can help you review and assess your options in order to determine your next steps.
- How do I appeal my STD benefits denial?
A: If your short term benefits claim is denied then you can try to appeal on your own, although this may sound like a daunting process. The insurance company may have already dragged you through an exhausting process demanding more and more paperwork and forms for information that you had already provided. Even if you had someone review your application carefully to make sure you did not miss any steps, they may still decide that you are ineligible for benefits.
Appealing a decision on your own is possible, but your chances of success may be poor. The insurance company is going to play tough, and do everything in their power to deny providing you with benefits. A disability lawyer knows exactly how to deal with the insurance companies, and just what it will take to bring them to the table. They will review and assess your claim and can determine what additional information you may need to obtain from your doctor or your employer that would increase your chances of success on a second try.
Working with a disability lawyer takes the stress of dealing with the insurance company off your plate, which lets you focus on your recovery while they fight to get you benefits. If the insurance company refuses to change their decision, your lawyer can walk you through the process of litigation if they recommend filing a claim against your insurer.
- Can I still apply for long term disability (LTD) if my STD claim is denied?
A: Yes, although your insurance company might try to tell you otherwise! Long term disability (LTD) benefits cover you for a much longer period of time in order to provide for lengthy illnesses. Depending on your illness and your coverage they can offer benefits for months, or even several years, although obviously the process is a bit different.
If you receive short term disability coverage but have not recovered by the time your benefits end, you can apply for long term disability benefits. You may need to push your insurance company for the paperwork if they are reluctant to provide it at your first request.
In order to qualify for long term disability benefits, you will need to show that you have been disabled during the application and waiting period, which can take several months. If your STD benefits have been denied, then your insurance company will try to use this as proof that you were not really sick during the application process. This is of course false, and simply another example of the insurance company trying to play games with your place.
If you are having trouble navigating either the STD or the LTD application process, a disability lawyer can help better explain the steps that you will need to take in order to improve your chances of success. This does not mean that the insurance company will say yes right away, but a lawyer knows exactly what it takes to bring them to the table, and can be tough with them so that they recognize why you need benefits coverage in order to properly recover.
- How much will it cost me to take legal action?
A: If your disability lawyer is working on contingency like we do, it should not cost you anything up-front to go after the insurance company or to file a claim. At Share Lawyers, we operate on contingency fees. That means that we get paid out of a portion of your winnings, which we outline in the retainer agreement that you sign when you hire us to represent your interests. It also means that we cover all of the costs of going up against the insurance companies, such as the costs of filing a claim or the costs of independent medical assessments, up front so that you do not have to worry about it until your matter is resolved.
When you are faced with a short term disability, be it a serious illness or a major injury or hospitalization, the first thing on your mind should be your recovery. Your health, and your absence from work to recover, can place a serious strain on your family’s finances and their wellbeing. That can be difficult enough, but can feel even worse when the insurance company that you thought would protect you is actively trying to deny your benefits.
At Share Lawyers, we specialize in Disability Insurance law. We have been fighting insurance companies since 1987 and we continue to do so every single day. We know how important disability benefits are in allowing your finances to remain stable while you focus on your recovery. Call us today for a free consultation where we can assess your case, and work with you to determine the best way to move forward. Remember, there are no fees unless you win your case.
If you have had your claim for long-term disability denied, contact the long-term disability insurance lawyers at Share Lawyers. We specialize in Disability Insurance Law. Our experienced team of long-term disability (LTD) lawyers can help. We have recently settled cases against Canada Life, Desjardins, Manulife, RBC Insurance, Sun Life, and many more. We offer free consultations and there are no fees unless we win your case. Find out if you have a disability case.