Whether you’ve been injured or sick, your current health condition can significantly impact on your ability to work and earn a full income. That’s when short-term disability insurance comes in.
It is a type of coverage that eases the financial stress of your illness or injury for a short period of time. It is meant to protect a portion of your income until your fully recover from your disability.
However, when people are often denied coverage, they appeal by sending a letter with accompanying evidence. Let’s see how it’s done.
Framing Your Case
Examine Your Denial Letter
Your insurer should give you a letter explaining why your short-term disability payments were refused. Examine this letter carefully and discover the reasons.
Determine How To Make An Appeal
The refusal letter should include instructions on how to file an appeal and any deadlines that must be met. Make a note of this information and mark deadlines on your calendar so you don’t forget.
If the information is not included in the letter, contact the insurance company right once.
Obtain A Copy Of Your Claim File As Well As Any Supporting Paperwork
If your company provides you with short-term disability benefits, you have the right to get a copy of your claim file, summary plan description, and policy. The plan administrator must send you this paperwork within 30 days.
Collect Any Supporting Paperwork
If you were refused because you did not give enough information, you must obtain that paperwork. You should include this supporting material with your appeal letter. You might want to get the following items, for example:
- medical documents from your doctor
- an opinion from your doctor or a second doctor
- written observations from coworkers or your employer on how the injury has impacted you
- additional records, such as police records if you were hurt in an accident
Consider Hiring A Lawyer
You might not know where to start when it comes to appealing. If this is the case, you might consider talking with a lawyer. However, keep in mind that attorneys do not work for free, so the cost of hiring one may surpass the amount of short-term disability benefits you seek.
Sending Your Letter of Appeal
The Letter Should Be Formatted
You should format the letter in the same way that you would a typical business letter. Set the font to something legible and double space the document. Times New Roman 12 point is usually plenty.
Give The Relevant Information
From reading your letter, the insurer should be able to determine who you are and why you are appealing. As a result, make sure you include the following information:
- your given name
- your insurance policy or identification number
- the reason why your insurer declined your claim
- a short explanation of your impairment
Explain To The Insurer Why You Should Be Granted Benefits
You should also openly request that the insurance modify its mind. Make a point of mentioning your supporting papers and arguing that it demonstrates your eligibility for benefits.
Include Any Supporting Documents You Have
Make copies of any papers you’re including—medical records, colleague notes, etc. Please do not send originals. You may also provide a copy of your application as well as the original refusal letter.
Submit The Letter Of Appeal
Make a duplicate of the letter for your records, and then send it certified mail, return receipt requested, to the insurance company’s address. Keep the receipt safe.
Wait For A Reply
Your appeal letter and supporting paperwork should be reviewed by the insurance company. You should receive a written answer.
Little Tip: Other appeals should be considered as well. The letter may inform you that you may file an additional appeal and how to do so. If your company provides short-term disability insurance, you may continue to appeal. You would first submit an appeal with an administrative judge, and then you may launch a case in federal court.