Experienced California Short-Term Disability Lawyers
Struggling with Short-Term Disability Claim Denials?
Have you recently filed a claim for short-term disability (STD) only to be denied? The challenges of dealing with a short-term disability can be overwhelming, especially when your insurer refuses to provide the support you need during this crucial time. You are struggling with your health, unable to work, and likely worried about covering your immediate and long-term expenses. We understand your concerns and are here to help you navigate this difficult time.
Short-term disability insurance is designed to provide financial support for a defined period of time (usually between six and twelve months) when you cannot work due to an illness or injury. If you are disabled, it is crucial to properly file a claim to ensure your benefits are paid.
At Kantor & Kantor, we are people helping people and are ready to fight for you. Contact us at 818-886-2525 for a free case evaluation.
At Kantor & Kantor, we understand the frustration and anxiety of a denied STD claim. Our legal team is dedicated to thoroughly reviewing your case, addressing oversights, and ensuring accuracy and consistency in your claim appeal. We offer a free case evaluation to discuss how our attorneys can assist you. Contact us now at 818-886-2525.
Why Choose Kantor & Kantor?
When facing the challenges of an STD claim, choosing the right legal representation is essential to ensuring your rights are protected and your interests are advocated for with utmost diligence. Kantor & Kantor stands out as a premier choice for individuals navigating the complexities of STD cases both in California and throughout the country. Here are some reasons to choose us.
Expertise in California Disability Law
Kantor & Kantor’s legal team boasts a wealth of expertise in California disability law. Adept in handling STD claims, we are at the forefront of legal developments, ensuring that clients benefit from the most current and effective strategies. The intricate nuances of California disability law demand a seasoned approach, and our attorneys are well-versed in the statutes, regulations, and case precedents that govern STD claims.
Aggressive Advocacy
Short-term and long-term disability claims often involve negotiations with insurance companies, requiring a firm and assertive legal stance. We excel in the art of aggressive advocacy, tirelessly pursuing the best interests of our clients. We are unafraid to take on insurance companies and other formidable opponents, leveraging our legal prowess to secure optimal outcomes for those we represent.
Proven Track Record of Success
One of the most compelling reasons to choose us is our consistent track record of securing favorable client outcomes. We have successfully litigated numerous STD and LTD cases, earning a reputation for achieving positive results even in the most challenging situations. This history of success is a testament to our commitment to delivering the highest standard of legal representation.
Exceptional Litigation
Our team is ready and willing to take cases to court, and we have successfully litigated a wide range of STD denials. We have the experience and expertise to navigate the legal complexities of STD claims.
What Is Short-Term Disability Insurance?
Short-term disability insurance is a financial safety net for employees facing income loss due to injury or illness. Unlike long-term disability (LTD) insurance, designed for extended periods of disability, STD provides coverage for a shorter duration, typically ranging from three to six months and sometimes up to a year.
Offered and funded by employers, STD can bridge the financial gap for employees during the waiting period before LTD benefits kick in. It ensures a steady income stream throughout the initial phase of illness, which is especially important if your LTD coverage begins after this initial phase, or for the entire duration of a short-term health setback.
What Qualifies for Short-Term Disability in California?
To qualify for STD benefits in California, individuals must meet specific criteria to ensure eligibility. Here are some common elements that generally qualify individuals for STD benefits:
- You must be incapable of performing your regular work for at least eight consecutive days. (There is a seven-day waiting period. During this time, benefits cannot be collected; eligibility begins on the eighth day.)
- Wage loss due to your disability is a prerequisite. For instance, no benefits will be received if your employer assigns you to a light-duty role while maintaining your current pay.
- A minimum earning of $300, subject to state disability insurance deductions, is necessary during your “base period.”
- You need to provide medical documentation certifying your disability. This documentation should come from a licensed health care provider, such as a doctor, who can attest to your condition’s severity and expected duration.
- At the time of disability onset, you must have been either employed or actively seeking employment.
Our attorneys at Kantor & Kantor are here to help you gather the necessary medical records and documentation to fight your STD claim denial for the disability benefits you are entitled to.
How We Can Help
At Kantor & Kantor, we offer comprehensive assistance for your STD claim through various specialized services.
1. Claim Denials
If your STD claim has been wrongfully denied, our legal team is adept in challenging such denials through a multi-faceted strategy. We challenge wrongful denials through appeals to the insurance company and, if necessary, litigation.
Additionally, if you are concerned about the possibility of your claim being denied, we provide proactive assistance in filing your claim to maximize the likelihood of approval.
Policy Review and Analysis
If your claim is denied, we review and analyze your policy. Understanding the intricacies of your insurance policy is crucial in maximizing your STD benefits. Our team conducts thorough policy reviews and analyses to strategize effectively for your case, ensuring that you know your rights and entitlements under your specific insurance coverage.
Documentation and Evidence Gathering
Building a compelling case to appeal a denied STD claim requires meticulous documentation and gathering of evidence. Our STD attorneys diligently compile all necessary medical records, expert opinions, and other relevant documentation to strengthen your claim.
2. Communication With Insurance Companies
Navigating the bureaucracy of insurance companies can be a daunting task. We act as a liaison between you and the insurance provider, ensuring that communication is clear, concise, and in accordance with legal standards. This proactive approach helps to prevent misunderstandings and streamlines the claims process, expediting the resolution of your case.
3. Litigation Support
In cases where negotiation and appeals are unsuccessful, we are prepared to take legal action on your behalf. Our experienced litigators are well-versed in disability insurance litigation, advocating for our clients in court to secure a favorable outcome.
Navigating Short-Term Disability Claims with Employer-Sponsored Insurance
When your employer provides STD insurance, federal laws likely govern how denials are handled. The Employee Retirement Income Security Act of 1974 (ERISA) regulates employer-sponsored plans where the employer is not a government or church entity.
While it was originally designed to protect pensioners from pension managers’ feloniously looting pension funds, it has evolved into an extremely complex statutory maze for claimants, which adds requirements prior to litigation while removing some of the most powerful financial punishments claimants could otherwise allege against insurers who wrongfully deny claims.
If your STD claim is denied under a plan governed by ERISA, you likely must file an appeal before pursuing legal action. Understanding the limitations imposed by ERISA is vital, and gathering all necessary documentation during the appeal process is essential. Kantor & Kantor’s experienced attorneys understand the unique characteristics of ERISA cases, ensuring you have the support you need.
What Are My Options After STD Expires?
Once STD benefits have expired, individuals requiring ongoing financial support are encouraged to consider LTD benefits if their disability is expected to persist. To substantiate a claim for LTD benefits, the following factors must be demonstrated. Additionally, it is important to note that individuals should also explore State Disability Insurance (SDI) as part of their financial planning, along with STD.
- Qualifying Medical Condition: The Social Security Administration (SSA) often refers to its “Blue Book” of medical impairments to assess whether a medical condition is eligible for benefits. The Blue Book provides a comprehensive list of conditions and their associated symptoms. While having a condition listed in the Blue Book, supported by credible medical evidence, enhances the likelihood of approval, the absence of a listing does not preclude approval. In such cases, additional medical evidence demonstrating symptoms and their disabling impact may be required.
- Disabling Condition: According to the SSA, a “disabling” condition is one that has lasted or is expected to last for a minimum of 12 consecutive calendar months. Although there are exceptions (such as blindness), the general rule is that an individual must be incapable of participating in “substantial gainful activity” to qualify for approval.
- Insurance Status or Financial Need: Applicants pursuing Social Security Disability Insurance (SSDI) benefits must establish their “insured” status, indicating they worked in a qualifying job for a sufficient duration and contributed to the Social Security system. Alternatively, individuals who did not meet the insured status but have income and resources below a specified level may qualify for Supplemental Security Income (SSI) benefits. Seeking advice from an attorney to determine eligibility for the type of benefits is strongly recommended.
Will a Short-Term Disability Claim Affect My Long-Term Disability Claim?
Many insurance holders opt for both short-term and long-term disability coverage. As previously explained, STD insurance can provide benefits before LTD benefits commence.
While the specific terms of policies may vary, it’s important to note that there are situations where simultaneous benefits under both STD and LTD can occur. In some cases, especially when STD is self-funded and LTD is insured, you may be eligible to receive benefits from both sources. However, it’s crucial to be aware that if you collect benefits from both STD and LTD, the LTD benefits may be adjusted or reduced by the amount received from STD.
It’s essential to understand that STD can play a significant role in supporting an LTD claim. Rather than viewing STD as a potential hindrance to LTD, consider it as a valuable resource that may be necessary to qualify for LTD benefits. Your STD information can be used to strengthen and support your LTD claim, emphasizing the importance of timely applications and consistent updates to your claims administrator to align with the eligibility criteria for LTD coverage.
Frequently Asked Questions
Does STD cover pre-existing conditions?
Short-term disability coverage does not extend to disabilities arising from pre-existing conditions. Even if you secure a policy through your employer without undergoing a medical examination, pre-existing conditions likely remain excluded from your coverage.
What happens if my short-term disability extends beyond the covered period?
If a disability extends beyond the covered period of STD benefits, individuals may transition to LTD benefits if they are eligible. The transition process and the terms of LTD benefits are usually outlined in the plan.
Is there a waiting period before STD benefits kick in?
The initial seven days of each new claim constitute a non-payable waiting period. The first day eligible for payment is the eighth day of your claim.
Consult an Experienced STD Lawyer in California
When faced with an injury or illness that prevents you from working, your primary focus should be on recovery, not worrying about fighting with an insurance company. Short-term disability insurance is a crucial support system during this period, ensuring a source of income until you’re ready to return to work.
Navigating disability insurance laws, however, can be challenging without legal guidance. The complexity often leads to some STD applicants’ being deemed ineligible and denied benefits, while others may initially receive approval only to face disqualification later on.
At Kantor & Kantor, we are people helping people and are dedicated to helping our clients obtain the rightful benefits they need. Whether you require aid with the initial STD application or are navigating an appeal, our team is here to lead you through the process, striving for the best possible outcome. Contact us at 818-886-2525 for a free consultation.
Attorney Glenn R. Kantor
Glenn Kantor is a founding partner of Kantor & Kantor LLP. As a young attorney, Glenn saw the injustice of wrongful insurance denials and created a law firm to represent individuals seeking to obtain their rightful benefits. Glenn is committed to ensure that clients receive the benefits they are entitled to under their insurance policies or group health plans. [Attorney Bio]
