If you are an employee, there is the possibility that you have disability benefits through your employer-sponsored health benefits. These benefits may include short- or long-term benefits that help cover lost wages in the event you have an injury or illness that prevents you from working.
Just like other insurance benefits, companies do not like to pay out benefits unless absolutely necessary, so it is not uncommon for them to deny a claim. In these instances, it is important to understand your rights.
Basics of short-term disability insurance
According to FindLaw, the specific benefits regarding short-term disability vary depending on the insurance company and each individual policy. There may be no waiting period before payments start, or there may be a specified period. The specific payments vary as well, but they are generally a percentage (average of 60 to 80%) of the employee’s salary. The average duration of a short-term disability policy is between three and six months, although some benefits pay out for up to two years.
Rights for insured individuals
The U.S. Department of Labor discusses that there is a federal law, known as the Employee Retirement Income Security Act, that sets minimum standards for private health plans to protect covered individuals. Some of these standards include:
- Providing information about plan features, participation, funding and benefit accrual
- Providing fiduciary responsibilities
- Giving participants the right to sue
- Establishing an appeals process
How to appeal a denial
If you receive a denial of your disability claim, you have the right to appeal the decision. The denial letter should include the reason for the denial, which will help you know how to handle the process. There should also be directions on how the process works. The specific steps you take will vary, but one of the important things to do is make sure you hang on to all records, including medical documentation. You should also pay attention to any deadline for appealing the claim.