My wife recently had a short-term disability claim approved. Shortly, thereafter, the same company, different department, denied her claim for long-term disability. We are forced to appeal the latter decision. Any ideas on how to start?

It is critical to read and review the definitions of LTD and STD. In some STD policies, disability is broadly defined as the inability to do your usual work, while for LTD, it may be more narrowly defined as the ability to do any work for which one is suited by training or experience. Thus, a brain surgeon could easily qualify for STD if illness made her hands shaky, but not LTD as she could still work as a non-surgeon doctor, giving second opinions, etc.

In addition, most insurance companies give much more scrutiny to claims for LTD benefits than STD as the LTD is far more potentially expensive in any one case. (And very often the decision on STD may as a practical matter be influenced by and/or effectively be made by the employer, as large employers may have a large deductible or self-insurance requirement.) So even if the definitions of LTD and STD are the same, the amount of evidence you see is greater.

Line up your evidence carefully. Better yet, consult an attorney to help you do so as there is a lot of money at stake and it’s worth a few hundred dollars to get your ducks in order.

Case Studies: Disability Claim Challenges and Appeals

Case Study 1: John’s Approval for Short-Term Disability, Denial for Long-Term Disability

John’s short-term disability claim was approved by Company A, but when he applied for long-term disability, Company B denied his claim. Now, John and his wife, Sarah, are forced to navigate the appeals process. This case illustrates the hurdles individuals like John face when dealing with different departments within the same company.

Case Study 2: Conflicting Definitions of Disability Impacting Mark’s Claim

Mark filed for disability benefits but encountered conflicting definitions. While his short-term disability policy defined disability broadly, the long-term disability policy had a narrower scope. Mark’s ability to work in any capacity, despite his condition, affected his claim outcome. This case emphasizes the importance of understanding policy definitions.

Case Study 3: Increased Scrutiny in Sarah’s Long-Term Disability Claim

Sarah’s long-term disability claim faced heightened scrutiny from her insurance company compared to her short-term disability claim. The potential for greater expenses influenced the decision-making process. This case showcases the additional evidence and challenges involved in pursuing long-term disability benefits.

Case Study 4: Seeking Legal Support for Appeals

When faced with disability claim challenges, it’s crucial to gather compelling evidence. In Mark’s case, seeking legal assistance became paramount to ensure a thorough appeal. This case emphasizes the value of consulting an attorney to navigate the complex disability claims process successfully.