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Disability Insurance

Why Was My Short-Term Disability Claim Denied?

Short-term disability plans are available to many workers in British Columbia through their employers, with the province mandating minimum coverage requirements for all plans. Short-term disability is an intended financial safety net for employees experiencing a temporary inability to work due to illness, injury, or chronic medical condition. Short-term disability has certain eligibility requirements that, if not met, can result in short-term disability denial.

Learn more about the common reasons for short-term disability denial, reapplying for short-term disability, and how short-term disability can be one step along the road to receiving long-term disability benefits.

Short-Term Disability Basics

You must be actively and gainfully employed to receive short-term disability benefits through your employer. Short-term disability insurance providers are required to provide benefits for a minimum of three months and up to a maximum of six months. Benefits recipients receive biweekly disability payments and can have up to 55% percent of their current wages replaced. These are the minimum requirements for short-term disability benefits providers and exact benefits can differ by policy. A manager HR representative should be able to provide you with the specifics of your employer’s plan.

Reasons for Short-Term Disability Denial in BC

1. Failure to Meet Eligibility Requirements

In addition to being employed and a minimum of 18 years old, employees must wait an interim period prior to the activation of their policy benefits. This is called an “elimination period” and it is the minimum amount of time one must work in a job prior to accessing benefit plans. Typical elimination periods are three months, however, eligibility is likely to involve working a minimum number of hours in jobs with irregular schedules. Employees must meet the requirements of their job, adhere to their employment contract (if applicable), and be employed at the time they become disabled. Both part-time and full-time workers can be eligible for short-term disability benefits. Those in non-traditional roles such as temporary contractors can be eligible under certain circumstances.

2. Incomplete Application

Short-term disability applications require three components:

  • A completed application form
  • An Employee Statement (this form can be provided by your employer)
  • An Attending Physician’s Statement

If any of these elements are absent from your short-term disability application, you will be denied. However, you can reapply up to three times.

Additionally, you’ll want to alert your employer of your intention to apply for short-term disability benefits. Firing employees for seeking short-term disability benefits constitutes wrongful dismissal.

The Attending Physician’s Statement acts as proof of your condition. This is in contrast to long-term disability benefits applications, which require more extensive medical documentation, including medical records and lab test results.

3. Your Symptoms or Diagnosis Aren’t Serious Enough

On the whole, short-term disability benefits have a lower medical threshold than long-term disability benefits and can cover a range of conditions that impact your mental and physical mental health in ways that prevent you from working your current job.

Fortunately for many benefits recipients, insurance companies no longer use a specified list of approved conditions and symptoms to determine medical eligibility for short-term disability. Applicants can receive benefits for just about any valid medical reason, as long as its severity is confirmed by a doctor. Generally, the Attending Physician’s Statement is enough to get approved for short-term disability benefits, but not always. Challenging a previous decision can take some modification of your original application, including seeing another doctor.

This can be especially important for those whose illness or injury may be enough to require long-term disability benefits. Being approved for short-term benefits isn’t a requirement for long-term disability but it can help build your long-term disability case.

4. You are Currently on BC’s Employment Insurance

BC’s Employment Insurance (EI) is a government-run safety net that permits workers to take up to six weeks away from work for a number of valid reasons. You cannot receive both EI benefits and short-term disability benefits at the same time. However, previously receiving EI benefits does not prevent someone from being eligible for or receiving STD benefits. Those who attempt to collect both benefits may be required to return the illegitimately awarded funds and made ineligible for future benefits.

5. You Fail to Fully Participate in Recommended Medical Treatment

One key—and sometimes overlooked—factor of disability benefits occurs after receiving approval. With several check-in points throughout the three to six-month benefits period requiring records documenting your medical progress, you’ll be expected to follow up with the doctor’s recommended treatments for your condition.

While it’s possible for benefits to last for six months, this is dependent on your medical progress. During this time, if your condition improves enough that the insurance company feels you can return to work, they may rescind benefits. On the other hand, if the insurance company suspects that you are not fully participating in treatment in order to maintain your disability benefits (sometimes referred to as malingering), they may accuse you of trying to receive those benefits in an unauthorized or fraudulent way and discontinue them.