By Peter Casciano, Esq.
Representing clients on Short Term Disability (STD) benefits claims is challenging due to the vast array of goals we may be trying to achieve. Some clients would like to use their STD benefits to take a temporary break from work. Those folks often have experienced a significant change in their medical condition and need to focus on their health to get back to normal. These clients may have suffered an injury or received a recommendation from their physician that a new course of treatment is preferred. These clients are planning on a relatively short break from work while they cope with their unique medical situation and hopefully improve.
Other clients know that they’ll never be returning to work. Some of these folks have already lost their job. Others have been told by their physician that they’ll never be medically capable of doing the job anymore. These clients are focused on a successful STD benefits claim as a means to an end: maximizing your chances of winning Long Term Disability (LTD) benefits.
The third group of people considering STD benefits claims is those that have no idea what the future may bring. Their medical picture or occupational picture, or both, may be entirely up in the air. They could be awaiting the results of crucial testing or an evaluation from a hard-to-access specialist. Either way, handling these claims can be different than other STD claims where the goal is more defined.
The right lawyer will speak with you about your particular vocational situation. They will review your clinical records and will ensure that the evidence in your claim sets up the outcome you hope to achieve. This outcome could include a return to work, a successful LTD claim, or an attempt to maintain the status quo.
When considering the different stages of an STD claim, the threshold issue to be confronted is whether or not the worker has STD coverage. Not every employer offers it, and sometimes it is an electable benefit by the employee. My advice is always to elect this benefit of employment if provided. The cost of each STD plan will vary from employee to employee. Some employers offer this benefit as a free option. Others will charge the employee a portion of the premium. The bottom line is that during your next open enrollment if an STD policy does not currently cover you, you should evaluate the cost with your HR department. This benefit can be invaluable during a medical crisis.
Assuming an STD policy covers you, the definition of disability in YOUR policy is the next thing to consider. Typically, STD policies define disability as your inability to perform the substantial and material duties of your occupation. However, not every policy is the same. Knowing your definition of disability is critical when discussing with your physician whether or not they will support your disability claim.
Discussing a possible disability claim with your doctor can be tricky. The easiest type of doctor discussion is when the physician takes control of the conversation and informs you of what you can and can’t do on your job. However, this isn’t always the case. Sometimes the patient will need to broach this topic, and it can be sensitive. By the time one gets to the stage where they are discussing LTD benefits, the employee has almost always stopped working, and the discussion is much simpler. For STD claims, however, the first conversation with your physician regarding work abilities can be tough. Be sure to be open and honest with the doctor, but make it clear you’d much rather work than not. Miscommunications that end with the doctor thinking the patient is “fishing” for disability benefits can be catastrophic.
Once the doctor has indicated they can support your disability claim, the next step is to find out what form(s) he/she needs to complete and how. In many instances, this is the stage where the employer’s HR department can make things more difficult. Some HR employees feel obligated to try to help with the STD claims. While usually well-intentioned, the employer should not be giving the claimant any advice regarding the completion of the employee’s forms, or the physician’s. Also, the physicians do not fill out disability forms regularly. The forms can be vague and misleading. The forms completed by the treating physician should be reviewed in detail to ensure complete accuracy.
Finally, once the STD claim filed, typically, there is a lot back and forth between the insurance company and the claimant. Many times, the insurance company repeatedly asks for seemingly the same information over and over. Despite the claimant’s frustration, one must do their best to be responsive to the insurance company by providing them what they want. Please be aware that insurance companies sometimes do overreach in terms of the evidence they demand. The insurance company is only allowed to demand evidence of the kind specified in the policy. The bottom line is that after the initial application is filed, the claimant is in a very precarious position, whether they are very much at the mercy of the insurance company. Many folks make unwitting errors while pending decision.
It is advisable that at each stage mentioned above, claimants consider hiring an attorney. STD claims have less money at stage relative to an LTD claim. Because of this, I suspect that many claimants try to handle themselves. As detailed above, there are many tricky aspects to an STD claim. Further, dealing with the above while trying to cope with your debilitating medical condition is sometimes impossible. An experienced disability benefits attorney is familiar with the different actions to take. Occasionally, we’ll act to defuse a claim that has become contentious and adversarial. Sometimes, we’ll know that its best to gather the evidence demanded rather than fight the request. Other times, we’ll refuse the request by the carrier, explaining that they are acting without authority from the policy. Each claim is different, and each client has different goals. Please feel free to contact me to discuss your claim and goals so that we can fashion the appropriate strategy for you.
If you need assistance in preparing your case, don’t hesitate to contact me for a free consultation.