There are times in a Florida employee’s career where he or she may not be able to work because of a medical condition. Whether it be a surgery, pregnancy, cancer, etc. short-term disability (or STD) insurance helps employees continue to receive compensation when they are not able to go to work. But there are instances in which a short-term disability claim may be denied.
If an employee has opted to purchase short-term disability insurance from their employer, or the employer provides disability insurance as a benefit, then the employee may be able to use STD insurance for illness or psychological impairment. It is important to note that the condition cannot be the result of a work injury as those would be covered under workers’ compensation.
Reasons a claim may be denied
However, there are circumstances in which a short-term disability claim may be denied. First, it may be that the medical condition isn’t covered. The fine print of the policy offers the medical conditions that are covered, and which are not. For instance, a C-section birth may be covered under some policies while not covered under other policies.
Second, a claim could be denied for inadequate medical evidence. It is important that a person applying for short-term disability provide the necessary medical proof that he or she is unable to work. If the insurance company doesn’t think the medical evidence is sufficient, the claim could be denied.
Another basis of denial can happen if the employee quits or is terminated before filing for STD benefits. A denial on this basis may or may not be justified depending upon the wording of the policy. For example, if the policy provides for coverage so long as the disability occurred while the employee was still working, then a denial because the employee filed for benefits after leaving the company may not be appropriate.
Finally, the insurance company could deny a claim if it believes the applicant is lying about a medical condition. Insurance adjusters may research to determine if a person really cannot work. The insurer may monitor social media accounts, talk to a person’s friends and coworkers or even conduct surveillance if they think there is a reason to deny a claim.
Those who have short-term disability coverage rightly believe they should be able to rely upon its coverage and be able to obtain the benefits should something happen. Unfortunately, sometimes the insurance company can stand in the way. Understanding disability law, the insurance process and how to challenge a denial is vital to obtaining much needed financial help.