Eight Reasons Short-Term Disability Can Be Denied


When you become unable to work for a short period of time, whether it’s due to a work injury or an unrelated illness or injury, you might be worried about where the money will come from to meet your regular bills. You could get benefits from a short-term disability policy if you meet the eligibility requirements.

But what happens if your insurer denies your claim? A Woodbury, NY, disability attorney from Fusco, Brandenstein & Rada, P.C. can help.

How Does Short-Term Disability Work in New York?

A worker in New York may receive short term disability benefits for injuries or illnesses that aren’t work-related. A worker may be eligible for these benefits if their condition prevents them from returning to work.

A breakdown of short-term disability benefits is as follows:

  • Benefits are cash-only
  • They pay 50 percent of an injured worker’s average weekly wage for the eight weeks they worked pre-illness or injury
  • Short term disability benefits cannot exceed the maximum allowed benefit (which is $170 per week as of this writing)
  • Social Security and Medicare taxes apply to short-term disability benefits

A worker may receive short-term disability payments for up to 26 weeks within a given 52-week span. In addition, a pregnant worker may be eligible to receive short-term disability benefits for the four weeks before their due date and for six weeks after giving birth. In the case of a Caesarian section, they may continue receiving short-term disability benefits for up to eight weeks after giving birth.

A worker who has given birth may also receive up to a maximum of 26 weeks of short-term disability benefits. Such a worker will need to provide medical evidence to demonstrate their eligibility.

Does New York Require Employers to Provide Short-Term Disability?

The law requires employers to provide disability benefits coverage. However, disability benefits might not apply to every worker. Employees may check the Coverage Requirements page for more information about eligibility.

An employer’s short term disability insurance provider may sometimes deny a claim when an employee seeks benefits. Reasons short-term disability can be denied include:

Insufficient Medical Evidence

A worker must provide medical records showing they have a medical condition that prevents them from working. Lack of sufficient medical evidence is a common reason for claim denial.

Failure to Meet Eligibility Requirements

An individual must be under a medical professional’s care to receive disability benefits. Other factors that can affect eligibility include:

  • Whether a worker has quit their job
  • Whether no-fault insurance has paid an injured worker after an auto accident
  • Whether a worker is unemployed at the time they become disabled

An attorney may help if you’re not sure whether you qualify for short term disability benefits.

Delays In Filing a Claim

Filing a claim within 30 days of becoming disabled is vital. A common reason a disability claim is denied is late filing.

You Have a Pre-existing Condition

A worker may be eligible for short-term disability benefits if they become unable to work due to a medical condition. According to the New York State Department of Financial Services, an insurance company can take pre-existing conditions into account when determining whether to pay disability claims.

Conditions Not Covered by The Policy

An insurer may deny a claim if a policy doesn’t cover a particular medical condition. An attorney can help review an insurance plan to confirm it doesn’t violate the law by not covering a particular condition.

Inconsistencies in Claimant Behavior and Statements

A claim could be denied if a claimant’s injuries don’t seem to be as severe as they say. For example, maybe a social media post shows a claimant playing sports. An insurer could use the post as evidence that the injuries are not serious.

Failure to Follow Treatment

Claimants should always adhere to treatment plans. An insurer can deny a claim if an injured worker doesn’t follow a doctor’s orders.

Missing or Incomplete Information

Completing paperwork thoroughly is essential when filing a claim. Any missing information can result in delays or rejections.

What Should You Do If Your Short-Term Disability Claim Was Denied?

You will receive a Notice of Rejection letter within 45 days of filing a claim if an insurer denies a claim. To initiate the appeal process, you may complete the reverse side of the form and mail it to:

Workers’ Compensation Board

Disability Benefits Bureau

PO Box 9029

Endicott, NY 13761-9029

 

How a Short-Term Disability Lawyer in Woodbury, NY Can Help You

Showing you deserve short-term disability benefits requires gathering medical records and other such documentation. At Fusco, Brandenstein & Rada, P.C., a Woodbury, NY, disability lawyer is on hand to offer legal help while you focus on your recovery. Let us take over your claim while you focus on your health. Call us at 516-496-0400 or contact us online for a free case review today.

 

 


Categories: Disability

Last Updated : December 7, 2023
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