Appealing a Denied Short Term Disability Claim Using New Evidence

You can appeal after applying for short term disability and receiving an insurance company denial. An appeal asks that the claim be reconsidered. Under the federal Retirement Income Security Act of 1974 (ERISA), a private insurance company must provide a full and fair review explaining the reasons for the denial. There may be one or more reasons, but one of the common ones is that there was insufficient evidence proving you inability to work or that your medical issues do not preclude you from pursuing your chosen occupation.

Upon receipt carefully read the insurance company denial review. There is typically a 60 day window for filing an appeal.

The first step is to contact the insurance company and request a detailed description of the types of documents that can serve as proof of symptoms or debilitating injuries. You need to also get precise deadline dates for filing the appeal. Ask the insurance company for any appeal forms that must be completed.

Collecting New Evidence

Once you better understand what documentation is accepted, the next step is to collect new evidence. New evidence includes family eye-witness accounts of how your symptoms prevent you from completing necessary activities and additional physician prepared written medical records. The most effective new evidence material will directly challenge the insurance company’s denial statements.

New evidence includes statements from employers, coworkers, family and friends. You can present medical research on your condition that proves your pain is real though it cannot be seen. You can present sick leave and annual leave records, time records and reports on lost wages due to your medical condition. Any documentation that supports your appeal should be included.

Write a letter explaining how the new evidence supports your short term disability claim. The letter and insurance company forms are mailed to the insurance company.

Meet All Filing Deadlines

It’s is important to file your appeal within the 60 day ERISA time period or other applicable deadline. At the end of the 60 days, the insurance company will close the claim. If the appeal is lost, the last step is to file a lawsuit and ask for a judge’s review of the case.  An attorney can be brought into the process at any stage of the process.

If your short term disability appeal is denied, it’s important to ask for yet another opportunity to appeal the claim denial. If the insurance company refuses the request then sending an explanatory letter to the appropriate state insurance agency is in order. This letter can be used to support your lawsuit should you pursue your claim to the next step.

If your short term disability claim is denied, don’t give up. You can submit new evidence on appeal and quite possibly win.

Talk to a Disability Attorney

If you are having trouble getting your disability claim approved, talk to a disability lawyer and find out what legal strategies you can employ to expedite the process and get your benefits.