Why Would a Short Term Disability Insurance Claim Be Denied?

In many states, and to varying degrees, Short-Term Disability (STD) insurance seeks to provide a financial safety net by covering a portion of your income if you’re unable to work due to a temporary injury or illness. However, it’s common for STD claims to be denied, even when they are valid. Below, we outline the common reasons STD claims are denied and offer practical advice to help you navigate the process and protect your right to benefits.

Missing or Incomplete Paperwork

One of the most frequent causes of STD claim denials is errors or omissions in paperwork. Insurers typically require multiple forms—often including statements from your physician and employer—and even a single missing signature can halt your claim. Another reason for claims to be denied? If you fail to respond promptly to requests for additional documentation, insurance claims adjusters will assume you no longer wish to pursue benefits or that you have inadequate proof.

You’ll want to be highly organized, even though you are unable to work because of your disability. If you can’t manage this task, you may want to consider retaining an attorney or asking a trusted, very organized family member to take over the paperwork for you. You’ll need to create a checklist of every form required (physician statement, employer statement, personal questionnaire, etc.) and track filing deadlines on a calendar. Don’t forget to double-check everything to be sure you’ve filled out all the documents completely, and make sure all the dates are correct and consistent. Staying on top of the paperwork can prevent administrative issues that often result in swift denials.

Insufficient Medical Evidence

Another common pitfall is inadequate proof of a disabling condition. Insurers want detailed, objective records confirming why you cannot perform your job duties, even temporarily. If your application for short-term disability includes vague doctor’s notes that fail to specify functional limitations, the insurance adjuster will question the severity of your condition.

Be sure the medical documents you provide are current, show consistent care, and don’t present a conflicting picture of your health.

Disability insurance attorney Jason Newfield devotes a fair amount of his time to discussing records with his clients’ doctors. This is because they – the treating physicians – are not knowledgeable about how disability claims work. It’s not their job. And their support staff is typically overwhelmed, also. Your claim is not their first priority. But when an attorney is developing a case to protect your short-term disability claim so that you will be better positioned for a long-term claim, how your medical records are presented is incredibly important.

Your request for detailed notes about your condition and treatment plan will be treated differently than when attorney Jason Newfield makes those requests. He will also make sure your medical records contain information about the physical or mental tasks of your occupation and how your disability makes it impossible for you to perform those tasks. Consistent, robust medical evidence helps insurers understand your diagnosis and how it prevents you from working.

Does Your Short-Term Disability Insurance Policy Contain Exclusions or Pre-Existing Conditions?

Before you file a disability insurance claim, it is critical to know what your STD policy covers, what it doesn’t, and what disability insurance benefits may be available. Many plans contain specific exclusions that can form the basis for denials. For instance, if your injury or illness started before your coverage began, your short-term disability insurer may argue it’s not covered. There are also policies that exclude certain injuries (e.g., self-inflicted injuries or complications from elective procedures).

Disability attorney Jason Newfield offers free policy reviews to help claimants understand the terms of their policies. Your policy may have riders, waiting periods, or exclusions that mean you won’t be covered. If you don’t know what they are, you won’t know how to prepare for a claim. This is critical when considering whether to file a claim for disability insurance benefits.

If you run into a situation where the insurance company challenges a condition, you will need to prepare by gathering strong documentation showing when your symptoms first appeared or when you received a diagnosis. Understanding the fine print of your STD plan can help you anticipate and address potential coverage issues as outlined in the short-term disability claims and appeals regulations and secure your disability insurance benefits.

Does your Short Term Disability Policy Include an Elimination Period? 

Most STD policies include a short elimination period—often 7 days—during which no benefits are paid. If you submit a claim before fulfilling the elimination period, this can result in immediate denial. So can return to work (even on a part-time basis) during this waiting period.

Review your policy so you know what the elimination period is and file a claim at the right time. Mark the exact start date of your disability and wait until you meet the policy’s minimum timeframe before filing. Also, keep thorough records of the date your symptoms started and any workplace absences.

Conflicting Information About Ability to Work

If you’re partially able to work, that discrepancy can lead to confusion and suspicion from insurers reviewing your STD claim. If you have a side hustle and are working or even volunteering, this may be used as evidence that you can still work.

Inconsistencies between what you state on your forms and what’s observed or noted in medical records will give the insurance company ammunition to question your claim.

Failure to Comply with Treatment Plans

Insurers generally require proof that you’re taking all reasonable steps to recover and return to work as soon as possible. This is where many claimants trip themselves up and put their claims at risk. If you miss appointments, refuse recommended treatments, or don’t follow a prescribed treatment plan, insurers may claim you’re not doing your part to regain the ability to work. Non-compliance can be interpreted as “lack of effort” to mitigate the disability.

If you know you are going to be filing a claim, or if you are on a claim, it’s very important that you attend scheduled appointments, follow prescribed treatments or physical therapy, and take medications as directed. In addition, you should maintain accurate and detailed notes of your appointments, therapies, and medications to demonstrate compliance. Do NOT rely upon your doctor’s office to maintain notes about all of your appointments, and don’t rely on your company’s HR office to accurately maintain notes about your absences or dates you leave early to go to doctor’s appointments. If you can’t manage the record keeping, ask a trusted person to help you.

Short-Term Disability insurance is designed to offer a financial lifeline when you can’t work due to a temporary medical issue. It is also the doorway to long-term disability insurance for many people. If you are unsuccessful in filing a claim for short-term disability and expect to be disabled for an extended period of time, you would be wise to contact Jason Newfield for a complimentary review of your policy and your overall situation.

Many companies self-insure their short-term Term Disability policies, meaning the company itself pays the benefits for employees who are temporarily unable to work. Often, the company contracts with a long-term disability insurance company or a third-party administrator company to manage the short-term claims, with the understanding that the employees on claim for Short Term Disability may need long-term disability coverage in the future. The same company trying to dodge its responsibility for short term is going to be less likely to want to pay benefits for Long-Term Disability. They will be relentless with paperwork during this process.

Do not treat your Short-Term Disability claim lightly. Contact short term disability attorney Jason Newfield to learn what you can expect from your insurance company. The call is free, and you’ll learn important information about your financial future.