Philadelphia Short-Term Disability Lawyer for Medical Professionals
A serious injury or illness can leave you unable to perform your essential job duties. Short-Term Disability insurance usually provides disability benefits during the gap in time between the onset date of your disability and the end of the elimination period of your Long- Term Disability Policy, usually between 90 and 180 days. Unfortunately, the claim process can be difficult to navigate, and claims aren’t always approved. If you’ve been injured or are suffering from an illness – including addiction, psychiatric disorders and physiological conditions – and are unable to work, a Philadelphia short-term disability lawyer can help you get the benefits you are entitled to so that you can focus on your health and recovery, and hopefully returning to work.
What Is Short-Term Disability?
Short-Term Disability is an insurance benefit that provides compensation for a limited period of time if you become injured or ill and are unable to perform your essential job duties. Many employers provide Short-Term Disability insurance for their employees as an employment benefit, but you can also purchase an Individual Disability Insurance policy. Short-Term Disability coverage is commonly provided to physicians, dentists, chiropractors, psychologists, high-level executives, and other medical professionals through their employment with Universities, hospitals, law firms, businesses, and groups.
Depending on the terms of your policy, Short-Term Disability typically provides coverage for three to six months and will pay anywhere from 60% to 80% of your pre-disability salary or earnings. Most disabling injuries and illnesses will be covered, with some exceptions, which will be outlined in either your Short-Term Disability or Individual Disability Insurance policies. Common exceptions are intentionally self-inflicted injuries or conditions (such as a suicide attempt) or commission of a crime.
Short-term disability insurance companies often disqualify people with pre-existing conditions from obtaining coverage or receiving benefits related to their condition. This may include cancer, heart disease, diabetes, back injuries, and neurological disorders. You may also have a longer waiting period to receive benefits, perhaps a year or more. A Philadelphia short-term disability law firm can help you review your policy and advise you as to whether your disability will be covered.
Our Philadelphia Short-Term Disability Lawyer Explains How Your Insurance Benefits are Paid
Short-Term Disability Insurance will typically begin paying benefits after a designated waiting period, which can take 7 to 14 days. from the time the disability occurred. Also referred to as the elimination period, this is the period of time for which you do not receive benefits. The longer the waiting period is, the lower your monthly premiums will be.
Benefits are often paid on injury claims more quickly because disabling injuries are typically easier to prove. Illness claims, on the other hand, may take longer because it can take some time to demonstrate your illness is serious enough to be disabling – preventing you from successfully carrying out the duties of your job. Depending on your policy, your benefits may be retroactive to the first day you missed work, once the appropriate waiting period has expired.
The Difference Between Short-Term Disability Insurance and Other Benefits
It’s important to understand that a Short-Term Disability claim is different from a Long-Term Disability claim. As the name implies, Short-Term Disability provides benefits for only a short time. Many employers offer both Short-Term Disability and Long-Term Disability coverage. Typically, your Short-Term Disability coverage will provide benefits until your Long-Term Disability goes into effect.
Because short-term disability insurance policies often have shorter elimination periods than long-term disability insurance policies, short-term coverage is a useful way to replace your income while you are waiting for your long-term coverage to kick in. By having both policies in place, you can also select a longer elimination period for your long-term policy, which will reduce the amount you pay in monthly premiums.
A Philadelphia Short-Term Disability Lawyer Will Help You Understand Eligibility Requirements
If you have purchased your own Short Term Disability insurance policy, your eligibility will be determined solely by the insurance company providing the policy. Of course, you will have to pay your premiums in order to have coverage when you need it.
For employer-provided plans, most full time employees qualify for Short-Term Disability benefits, provided they meet the requirements of the Short-Term Disability Insurance policy or their employer’s plan. Common requirements for eligibility include:
- You must be a full-time employee.
- You must have worked for your employer for a minimum period of time (for example, you must have been employed for six weeks before you will be eligible for disability coverage).
- You must meet a minimum earnings requirement.
These requirements vary by plan and by provider. A Philadelphia short-term disability attorney at Seltzer & Associates can review your policy to determine whether you are eligible for benefits. We can assist in filing your disability claim and ensure you receive the monetary benefits you need to restore your health and to which you are entitled.
A Philadelphia Short Term Disability Attorney Can Also Handle Denials and Appeals
Too often, legitimate short-term disability claims are denied by insurance companies seeking to save money. A Philadelphia short term disability insurance denial lawyer can help you appeal the insurance company’s wrongful denial of your claim.
What Can You Do to Appeal a Short-Term Disability Claim Denial?
There are several steps you can take to appeal a denial of your short-term disability claim.
- Identify the reason your claim was denied. Your insurance company will send you a denial letter, which will set forth its reasons for denying your claim. Read this letter carefully. Often the reason cited is a technical one — a coding mistake or missing information — that will be easy to address. Other times, however, the denial will be because the insurance company disputes your eligibility on other grounds — alleging the illness you claim is not covered, for instance — and that may require the assistance of a Philadelphia short term disability insurance appeals attorney to sort out.
- Review your policy’s procedures for filing appeals, including the deadlines. The deadline for filing the appeal will typically be 180 days, but you want to make note of the exact date set forth in the denial letter. If you are unclear about the deadline, contact the insurance company for clarification. If you miss the deadline, you will likely lose your right to contest the insurance company decision.
- Review the information the insurance company has on file. If the denial was based on anything other than a simple clerical error in the original claim form filing, you need to find out precisely what information the insurance company relied upon in issuing its denial. To do this, you will need to request a copy of the administrative file. Ask that expedited copies be sent to you as soon as possible.
- Gather all the information you will need to support your appeal. Depending on your review of the insurance company’s file, you may want to gather additional documentation from your treating physician, a second opinion from another provider, and even written observations by colleagues if they can help strengthen your case for benefits. If you experienced some sort of trauma — such as a car or other type of accident — documentation like police reports and witness statements can also be helpful.
- Draft a detailed appeals letter and send it before the deadline. It is important for you to understand that you are only entitled to one appeal. As you are only entitled to one appeal, it is important that you clearly set forth all the information supporting your appeal in a persuasive letter or on the form that the insurance company provides. Documentation should be clearly labeled and referenced in the appeal. If you have not already done so, consulting with a Philadelphia short term disability insurance denial lawyer before sending in the appeal is recommended to ensure your rights are protected. The last thing you want is for your appeal to be denied based on either a technicality or your failure to provide all the evidence at your disposal in support of your claim.
Short-Term Disability FAQs
What Is the Difference Between Short-Term and Long-Term Disability?
Both short-term and long-term disability insurance are designed to cover you following an injury or medical condition. Short-term disability is meant to replace your income for a short designated period. In contrast, long-term disability insurance is intended to maintain income replacement if you continue to be disabled after the short-term policy lapses. Long-term disability, however, does not typically kick in until 60 to 90 days from the date you filed the short -term disability claim. It is meant to be a continuation of disability benefits once short-term benefits have been exhausted and can often cover you into retirement.
What Does Short-Term Disability Insurance Cover?
Generally speaking, eligibility for benefits is tied to your ability to perform your current occupational duties. Your policy may also require the loss of a certain percentage of earnings due to disability. You may be required to provide the carrier with updated medical information to verify your disability and continued eligibility for benefits beyond your claim’s initial approval.
Keep in mind that in addition to injuries and illnesses that limit your ability to work, surgical procedures that are deemed medically necessary will qualify you for short-term disability benefits. Some policies will provide benefits for bariatric weight-loss surgeries. Organ donation is typically covered as well. Purely cosmetic procedures are not likely to be covered. If prescription medications or medical procedures cause side effects that keep you from working, you may also qualify for benefits.
If your policy includes residual disability coverage, you should be able to recover benefits in the event you become partially disabled but are still able to work in your primary specialty. This coverage eliminates the “all or nothing” assumption of disability insurance. For example, if you have at least 15 or 20% reduction of income due to illness or injury, you should be able to recover a partial benefit. The same is true if you have a disability that only allows you to work limited hours. A Philadelphia short-term disability lawyer can help facilitate your recovery of benefits so that there is no interruption in coverage.
How is Short-Term Disability Calculated?
As mentioned above, Short-Term Disability benefits will typically pay 60% to 80% of your salary or wages during the time that you are unable to work for a short period of time. The amount of your benefits will be based on your income. In addition, your benefits may be subject to a cap. For example, your Short-Term Disability insurance may pay 80% of your weekly income up to a certain maximum benefit. An experienced Philadelphia Short-Term Disability lawyer can help you calculate the amount of benefits you are entitled to receive under your policy.
It is also important to understand the tax implications of any short-term disability benefits paid so that the plans you purchase replace the actual income you might be losing should you become disabled. Disability insurance policy benefits may be taxable or tax-free, depending on who paid the premiums. For example, if your employer paid the premium for your group coverage without including the cost in your gross income, any short-term disability benefits would be taxable.
How a Philadelphia Short-Term Disability Lawyer Can Help Medical Providers and Other Professionals
The team at Seltzer & Associates focuses exclusively on Short-Term Disability, Long-Term Disability, and Individual Disability Insurance claims and cases — especially for medical professionals. We can review your company’s employee benefit package and your individual Short-Term Disability policy. We then explain to you what injuries or illnesses are covered, whether you are eligible, and what you must do in order to file a claim.
Our Philadelphia disability attorneys can also help you navigate the claim process. We will make sure your claim is presented in the most complete and well-supported way, including providing the necessary documentation, and completing the required paperwork.
Finally, a lawyer on our team can help you fight a denial of your claim. If your claim has been denied, you have the right to appeal that decision. However, you must file your appeal timely, and you will need to build a persuasive argument showing why your claim was wrongfully denied. If you fail to file an appeal or do not file it correctly, you could lose your right to benefits.
Contact a Philadelphia Short-Term Disability Lawyer Today
The disability insurance lawyers at Seltzer & Associates have the knowledge, skill, and experience to help you get the benefits you deserve. If you are facing a Short-Term Disability claim, let us help – call us at 888-699-4222 or contact us online to schedule a free consultation with one of our Philadelphia Short-Term Disability Attorneys today.