Short-Term Disability Insurance

Many working professionals choose to protect their incomes and livelihoods through short-term disability insurance, especially if their chosen occupation comes with a certain level of risk. Some employers also offer short-term disability insurance as an employment benefit. Policyholders or their employers will pay a monthly premium to maintain coverage.

Short-term disability insurance is designed to cover temporary injuries and illnesses that policyholders will generally recover from. Examples of conditions that might be covered under a plan include an incapacitating illness, a broken limb, a debilitating surgery, or childbirth complications.

These policies can cover up to 60% of a policyholder’s paycheck during a benefit period. Some plans impose maximum caps.

When a policyholder sustains a qualifying injury or illness that prevents them from working, they will submit a claim that includes evidence of the condition. In most cases, you will need to also provide a professional medical opinion that verifies that you are temporarily unable to work. If your claim is approved, you will need to wait through an “elimination period” before you can start receiving benefits. Many policies’ waiting periods last about two weeks.

Once the elimination period is over, your benefit period will begin. A set portion of your paycheck will be covered until you have recovered, your benefit period ends, or your maximum cap is reached, whichever comes first. The scope and duration of your benefit period will depend on your specific insurance policy. Most plans will cover at least several months. Our Indianapolis short-term disability insurance attorneys can carefully evaluate your policy and help you understand what you are entitled to.

Short-term disability insurance policies are meant to cover situations where an injured or ill person can return to work within a few months. Both long-term disability insurance and Social Security Disability Insurance (SSDI) cover cases where someone will be unable to work for a significantly longer period of time.

Long-term disability insurance functions similarly to short-term disability insurance. Policyholders pay a monthly premium in exchange for a portion of their paycheck being covered if they cannot work. However, coverage generally only triggers when someone will be unable to work for at least three months. These policies tend to cover up to 80% of a policyholder’s paycheck, and certain plans can allow for benefit periods of years, decades, or even until retirement. However, these policies typically impose longer elimination periods and are considerably more expensive than short-term disability policies.

Short-term disability and long-term disability insurance policies are private arrangements, while Social Security Disability Insurance (SSDI) is a public government benefit program. Workers who work jobs covered by Social Security accrue work credits. If someone sustains a qualifying disability and will consequently be unable to work for a year or more, they may qualify for monetary benefits if they have sufficient work credits.

Some insurance companies habitually deny claims on arbitrary or insufficient grounds. When a claim is rejected, the policyholder will not receive the benefits they are depending on in their time of need. Insurance companies will resort to many excuses to justify a denied claim, including:

1. Insufficient medical evidence.

When submitting a claim, a policyholder must convince their insurance company that their injury or illness prevents them from working. This will generally involve providing a professional medical diagnosis that confirms the policyholder should not work until they recover. Insurance carriers will sometimes send medical evidence to their own doctors and obtain a dissenting opinion. The contradictory opinion can be used to reject a claim.

2. Injury or illness not covered by the policy.

Some plans will only cover certain types of conditions, and certain ailments may be explicitly excluded. Some insurers will even use deliberately ambiguous policy language to justify denial of benefits, even if an injury or illness appears to be covered.

3. Fraud.

It is important to be accurate and precise when submitting a claim to your insurance carrier, as they will heavily scrutinize any perceived inconsistency. If an insurance company believes it has been misled, it may attempt to deny benefits.