Human Resource Blog

Insurance Company Inappropriately Denied STD

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What recourse does a resident of Illinois have when an insurance company denies payment of a legitimate claim on an employee covered short-term disabilitly policy? In this case, [company name deleted] denied the claim even though the physician and employer advocated on behalf of claimant whose short-term visual disability rendered her unable to perform former eye-intensive research duties.

This is actually a question pertaining to the insurance industry, not to Human Resources. However, we’re happy to help.

Almost any insurance claim that is denied can be appealed. Usually, there is information right on the denial form, on the steps to take to file an appeal. If this is not available, then contact the insurance carrier or the company HR department.

Often, if the initial appeal is denied, it is possible to appeal that decision again.

While most individuals won’t hire an attorney for the appeal, a few do hire someone specializing in insurance law.

Sadly, too many insurance companies routinely deny claims such as this one for short term disability. Some companies regularly approve such claims, when an appeal is filed.

The documentation that you have is in your favor. It is possible that the insurance company will request additional information or documentation from the doctor. In some cases, an employee is even asked to see another doctor for a second opinion (at the insurance company’s or employer’s expense.)

Don’t delay in filing an appeal. Normally, there is a time limit – often 60 days – during which the appeal must be filed.

Also be aware that under the ADA, the Americans with Disabilities Act, the employer must make reasonable accommodations for an employee’s disability. This includes a temporary disability. If, for example, providing special lighting, magnification or a special oversized computer monitor would make it possible for you to do your work, then usually the employer must comply.