If My Short Term Disability Claim Is Denied Do I Need To File A Separate Long Term Disability Claim?

If a short-term disability claim is denied and you're a claimant who is looking to get onto long-term disability, the question is at that point in time can you file or do you need to file an application for a long-term disability or since your short-term disability has already been denied and you've done an appeal and you're probably going to sue the disability carrier anyhow, do you just go ahead and sue them for short-term and long-term at the same time? While addressing the first question, I think if it's something that's going to tentatively go into a long-term disability claim, it's important to start that process early. Some companies will say that there'll be a transition rollover once your short-term disability is almost over, it'll go into long-term disability. Some do require separate application to be made, but if it is something that is going to go into long-term, you probably want to start that earlier on because despite the fact it's going to the same company, it's two completely different processes. Because on the short-term, the long-term, I think absolutely it's usually, I'd say almost in 98% of the time, it's a totally different person, entity of the company, often even a different company that will handle a long-term disability. So nobody should think that, oh, I rolled right through the short-term, therefore the long-term is going to be no problem. And also one other thing with respect to that, the vast majority of short-term disability policies aren't underwritten by the insurance company. What that means is any payment they make isn't coming out of their funds. Say, for instance, you have a Hartford long-term policy with your carrier and they take care of the short-term, they're the plan administrator more often than not. So what ends up happening is your short-term disability benefit is coming from the assets of your company that you work for. So you usually see short-term disability claims being approved, in my opinion, it's because it's not coming out of the insurance company's pockets. But when that rollover to long-term comes, when it is going to be underwritten by the insurance company, and they're responsible for payments, the level of review and scrutiny is that much harder to overcome. Okay. So the second scenario is you've been denied for short-term, you appealed it. In the meantime, even while that appeal is pending, you want to apply for long-term. Disability carrier says, no, we're not going to take your application for long-term. Is that a denial? Can they say, no, we're not going to consider the long-term disability? You know, I think it would really depend on, you know, what's in the letter that they send you. If they indicate that, no, you can't apply for a long-term because of the fact you didn't satisfy the short-term disability policy, I think that does open grounds to be able to argue that's a de facto denial of long-term, that trying to apply or do anything with it would be futile. So you would have the ability to also bring a suit for the long-term policy as well. And futile is a key legal word that we've seen in the case law, where basically if it would be futile to appeal for the long-term disability, then you don't have to, because ERISA requires you to submit an appeal back to the company before you can file a lawsuit. When you are going to apply for that long-term disability, and then they say, no, would you recommend someone appeals their decision to say no as well? You know, I think that would, if you want to cover all your bases to protect it, I'd say yes. More often than not, though, in a denial letter from any insurance company and ERISA, they're going to have to explain your rights to appeal and ERISA in there. So if that's absent, I think that does create some type of gray area. In an abundance of caution, I think it'd always be important to at least say that you, if you had to, you satisfied any administrative remedy you had before you could bring a lawsuit, which is your appeal. I don't think it would hurt, but at the end of the day, too, I think it's going to end up in the same result of a denial. And I think it's a delay tactic when they deny the short-term and then say, you can't apply for long-term. So I always advise people apply for the long-term. If they deny you, you're in a much better position to then file a lawsuit for both of them. If they're not going to take your long-term disability application, then they're going to say right away, we're just not going to take it. Then we know we can comfortably sue for short-term and long-term. But how many times have you seen where the short-term is denied, we help the claimant apply for long-term and the long-term gets approved? That does surprisingly happen. A lot of people think it won't. I've had that happen on several occasions. And then usually once that approval letter comes, it's a matter of going back to the short-term carrier claims manager and pretty much demanding that money be paid because to get long-term, they found you were disabled during the elimination period, which is your short-term disability period. So bottom line is that if you're transitioning from short-term to long-term, the short-term has been denied and you're not sure what you should do with the long-term disability claim, whether you need to apply or just go ahead and file a lawsuit. There's so many different scenarios that we're trying to talk about. And it probably sounds a little bit confusing to you. 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