Disability Benefits

5 Things Every Employee Should Know About Short Term And Long Term Disability Benefits

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Long-term disability benefits, if offered by your employer, can assist you to meet your financial responsibilities while you are not able to work and not receiving your regular wages. Keep in mind that not all employers offer this type of insurance, and if they do, an employee may have had to sign up for it or even pay a portion of the monthly premiums. So, if you are not sure if you have this benefit, contact your employer’s human resources office, and they should be able to supply you with that information and even hand you a claim form if you are ready to file a disability claim.

In the meantime, to make sure you have all of the information that you need to know, we have put together a quick list of 5 things you should know about these types of benefits as you continue through the claim process:

#1. There is generally a waiting period between the time you are deemed disabled by a medical professional and when you are eligible to receive disability benefits. Most long term and short term disability plans require a waiting period to pass before you are allowed to make a claim for benefits. We have seen waiting periods that last between 30 and 180 days. Some long-term policies have a 180-day waiting period where you can exhaust a short-term disability policy is one is offered.

#2. The insurance company is who decides whether you can be approved or denied your disability benefits NOT your employer. The insurance company who supplies the disability policy to your employer is the one to make the final decision as to whether they will pay out on your claim or not. This is the main reason that many claims are denied when they should have been approved. Every policy should have in place a process for a claim to be submitted and what to do once one is rejected. There is generally an appeals process after a denial that allows the claimant to provide additional information to the insurance company, to hopefully change their mind. As in most insurance claims, changing the mind of an insurance company is very difficult and time-consuming. That is why we encourage you to reach out to an attorney for guidance. With specific policy requirements in place, an appeal can quickly be ruined if you are not careful and follow everything to a “T.”

#3. Some disability policies require reevaluations after so many payments. That’s right, your disability insurance, if approved for payment, will be reevaluated every so often to ensure that your health or status has not changed. In other words, just because you are approved for benefits does not mean they cannot deny you later. We see this happen all of the time. You will be required to go through evaluations periodically depending on the insurance company associated with your disability policy. Keeping up with this process is essential so that your benefits continue until they are exhausted.


#4. Following your doctor’s advice is imperative when it comes to disability claims. Insurance companies will rely on your medical records, along with their opinions, to determine whether you are disabled enough not to work. It is crucial for your claim to make sure that you not only follow your doctor’s advice but that your doctor is told that you are filing for disability benefits. This will ensure that your medical records are accurate and have an accurate reflection of your health. Once you begin the claims process, the insurance company will reach out to your doctors to ensure that you have the health conditions you are claiming and they will want medical evidence of them. The better documented your issues are, the better your chances are that your claim will be approved.

#5. You may need the help of an attorney to file a claim and should never file an appeal without speaking to one first. Every insurance policy has specific language that is set further when you sign up. That language will document the process for filing a claim and filing an appeal. Most employees do not read the policy language, and most employers do not understand the policy language. Relying on an HR rep or insurance adjuster to help you through the disability claims process is a mistake. You need someone who has experience dealing with insurance companies and the tactics they use to ensure that they keep their money, and you lose out.

Both the long and short-term disability claim’s process is cumbersome. There are many requirements that you must meet before your claim is approved. If you have questions on the process or need assistance, feel free to contact our office. If in fact, you have filed a claim and received a denial letter, contact our office immediately as time is running short on your appeals process.

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Written by
Tim Miley
Tim Miley is the founder of The Miley Legal Group. After earning his undergraduate degree in finance at Southern Methodist University in Dallas, TX, Tim attended Duquesne University in Pittsburgh, PA, where he received his Juris Doctorate. Tim is admitted to practice in all courts in West Virginia and is currently a member of the American Association for Justice, the West Virginia American Association for Justice, the West Virginia Bar Association and the Harrison County Bar Association.
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