Many Short Term Disability (STD) denial letters read as if they took all of five minutes to write. The insurance company says little more than “we don’t think you’re disabled.” They say you can appeal, but with so little to go on, it can be hard to even know where to start. Gee, it almost seems as if they designed it that way, counting on you to just give up on your claim, doesn’t it?
The truth is that many people do give up, and it has nothing to do with the strength of their claim. Lower overall case values and shorter duration claims mean that finding assistance for Short Term Disability appeals is difficult or impossible. Unless you have some experience in analyzing arguments and preparing effective counterarguments, mounting an effective appeal seems about as far-fetched as flying to the moon.
And yet, we made it to the moon. And if you have what should be a valid Short Term Disability claim, you can make it to the appeal finish line. Here’s how:
- Understand what the finished appeal product needs to look like. You do not have to reinvent the wheel. There’s a format for successful appeal letters that you can use as a model for your appeal. If you haven’t already, download a copy of our free guide, Recover Your Benefits: Keys to Successfully Navigating the Disability or Life Insurance Appeal Process. I know you don’t want to read a book. But you kind of have to in order to learn how to craft a successful appeal. Just download it and take it a step at a time, and see how far you get. I tried to make it fun. Okay, not fun, but at least not deadly boring.
- Understand what went wrong with your claim. The denial letter is supposed to tell you, but most denial letters are very hard to comprehend if the language is new to you. It’s really important to talk with someone who knows what the insurance company is getting at based on the language they use in your denial letter. Which brings us to more free stuff! Contact us with a copy of your denial letter and we’ll explain the insurance company jargon and what it really means for your claim and how to fight back in an appeal. It’s free, really – once you’ve read hundreds of these letters, as we have, the patterns jump out and it doesn’t take us long to explain it in layman’s terms. We’ll tell you how to take the next steps with us if you want, but we’re also rooting for you if you decide to tackle this on your own. (Despite the earlier “made it to the moon” analogy, this isn’t rocket science.)
- Start your appeal letter. This isn’t the kind of thing you can knock out in one sitting anyway. Just get it started now, and give yourself the structure you’ll need to add all the pieces in the right places. Include your name, address and contact information. Add a placeholder for the date, and make sure it’s before the appeal deadline. Refer to your denial letter for the address to use for the insurance company. Give your appeal letter a Subject line, like “Re: Short Term Disability Claim Number (use the number on your denial letter).” Start out, “Dear (Insurance Company), I have received your denial letter dated (date of your denial letter). This is my appeal of your decision to deny my claim.” Add these placeholders for your sections:
- Context for your claim (what happened, what your job is like, why were you unable to work)
- Evidence for your claim (medical records that show the treatment you’ve been getting, statements from your doctor(s) about what functional restrictions and limitations you have as a result of your medical condition, test results, etc.)
- What the denial letter got wrong (is the disability insurance company missing medical records? Cherry picking details from your records that are irrelevant? Misstating the requirements of your job? etc.). One issue common to many Short Term Disability denials in particular is that the insurance company didn’t get anything specific wrong because the letter didn’t really say anything. In that case, it’s important to call them out for their lack of detail.
- Talk to your doctor. You will not win a disability appeal without support from your doctor. It really is that simple and inescapable. The insurance company has set up their claim evaluation system to either agree or disagree with your doctor. If your doctor says you are not disabled, the insurance company just has to agree and move on. (We’re here because if your doctor says you ARE disabled, the insurance company can also simply say, “we reviewed your medical records and there is no support for your doctor’s opinion.” You lose either way, but at least this second way leaves room for an appeal).
- If you haven’t yet seen your doctor, go see your doctor. Life moves fast, and sometimes you need to stop working first. But go see a doctor as quickly as you can to document the symptoms that put you out of work. If you can’t get in to see your doctor, Urgent Care might be your best option.
- Collect your medical records and other evidence that supports your claim. While your claim was pending, the insurance company probably told you they would request your medical records. For the appeal, you need to request your records yourself and send them to the insurance company as attachments to your appeal. Before you send them, read them and make sure that they “explain” your claim through test results, exam results, doctor notes, etc. Other evidence you can send with your appeal:
- a statement from your doctor saying they read the denial letter and disagree with the decision to deny your claim, because (they should add any relevant details about your medical condition, describe your restrictions and limitations that interfere with your job requirements, and discuss your treatment plan and prognosis).
- a job description from your employer, especially if the insurance company is mistaken about what your job requirements are.
- letters from family/friends/colleagues who can describe how your disability has affected your performance in and out of work.
- anything else that helps explain your claim. We’ve sent photos of injuries, video of clients trying to perform activities of daily living, symptoms logs that document the severity, frequency and functional impact of subjective symptoms like pain, and more. It’s your appeal – if you can think of something that helps prove your claim, send it to the insurance company.
- Revise your appeal letter. Go back and plug in what you’ve collected in the appropriate sections. Describe your attachments in the body of the appeal and list them at the end of your letter. Have someone read the appeal letter through to make sure it tells the story of your claim and is supported by convincing evidence. Now, THAT’S a strong appeal!
- Send the appeal letter on time and track receipt. If you email the appeal letter and attachments, make sure you get confirmation that it was received. If you fax it, keep the fax confirmation page. If you mail it, use some service that confirms it was delivered (Fedex does this automatically, USPS requires you to buy this additional service).
- Stay engaged and be responsive. When you get the appeal out the door, it feels like you reached a finish line. But you also reached a new starting line for the next phase of your appeal. As the insurance company reviews the appeal, they may have questions for you and your doctor, and they may send you new reports to comment on. It’s a pain, but you have to respond. Persistence is key when it comes to a successful appeal.
