While you’re rightly concerned with the monetary benefit amount of your claim, it also pays to be aware of other claims and any other non-monetary factors that might be involved with your claim. You might have one denial letter, but two or more claims or policies that need attention. This applies especially to disability claims.
Frequently, you may have been denied for Short-Term Disability benefits (STD), but will also need to make a Long-Term Disability (LTD) claim, even as you work on your STD appeal. Especially if your employer uses two different insurance companies (such as Sedgwick for your STD plan and New York Life to administer your LTD plan), it’s important to treat both claims as separate claims and apply for LTD according to the instructions in the LTD policy. If a claim manager tells you that you cannot apply for LTD since STD was denied, they are probably wrong. You’ll need to check your policy to be sure, but in most benefit plans, these are separate benefits and LTD eligibility is not dependent on STD approval. While it can seem like a longshot to get approved for LTD if STD is denied, it’s actually not uncommon. The STD and LTD claim evaluation teams are separate, and often the LTD team just does a better job with claim evaluations. If nothing else, having a separate LTD denial letter effectively gives you another chance to appeal. And getting approved for LTD can make your STD appeal a breeze!
Many employers offer both life insurance and disability benefits, and while the policies are separate, the claims can be linked. Most life insurance policies will waive your life insurance premium and continue your coverage while you are disabled. This is often called a Life Waiver of Premium (LWOP). If the insurance company decides you are no longer disabled, that can affect your eligibility for LWOP, and you can lose your life insurance coverage as well as your disability coverage when your disability claim is denied.
Every employer is different, but some employers will continue your status as a company employee while you are approved for disability benefits, which can make you eligible for continued health insurance, pension benefits, etc. That status changes or goes away entirely when your disability claim is denied. It’s not uncommon to hear from your employer soon after you receive a disability denial letter that your status and benefits with them have changed. You may have been considered an employee while receiving disability benefits, but are terminated as soon as your benefits stop.
Maintaining LWOP eligibility (or health insurance coverage, or pension benefits, depending on your policy and employer) is a top reason why it may make sense for you to go through a disability appeal even when your monthly benefit amount is low.
If you’re at all unclear about what other benefits may be impacted by your current denial, be sure to reach out to your employer to ask. Every employer is different, but if you let them know that you are appealing the denial, some will even agree to maintain the same status you had prior to the denial while you wait for the appeal decision. If you think you are being mistreated, contact an employment attorney to discuss next steps.
