NO IS NOT DENIAL
Learning to Negotiate the Disability Landmine By Leonitta L. Turner
Nationally, Human
Resource professionals are gearing up for the dreaded “Open Enroll- ment”. During this time period, anxious employees will inundate Human Resource representatives with questions about their insurance plans. HR professionals will be asked to decipher what each plan means, suggest what benefits employees should choose and determine what they can afford.
Most individuals elect to participate in their medical, dental, vision, and long-term disability insurance plans; however, many people play “Russian Roulette” with short-term disability insurance.
They reason, ‘nothing will hap- pen to me; I’m young, healthy...’ (fill in the blank). Short-term disability insurance provides a benefit based on a percentage of base earnings should you become disabled. Most plans consider an individual disabled when they can no longer work due to a covered injury, physical disease, mental disorder or pregnancy.
Individuals express many reasons for not purchasing short-
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term disability insurance. The cost for short-term disability insurance can be steep and often there is a brief waiting period before benefits are paid. The plan may not pay benefits until sick or personal leave is exhausted. Depending on the plan, a pre-existing condition could prohibit the insured from collecting benefits if the injury or illness occurs within 12 months of the policy being issued. Additionally, the average benefit amount for most short-term disability plans is 60-65% of base wage. The definition of short-term disability and the eligibility requirements may differ from plan to plan. Therefore, understanding what you are eligible for and when, can be daunting. Combine insur- ance jargon with legal rhetoric and it is easy to understand why many people quickly acquiesce when they are denied. In today’s economy, you need to understand the road- blocks to collecting short-term disability insurance benefits so you can maneuver through them.
KNOW YOUR PLAN It is imperative for you to know your plan. If medical treatment or advice for a medical condition is received prior to obtaining coverage, the claim could be denied. This is because many plans have an elimi-
nation period or pre-existing condition clause that requires a 12 month waiting period from the date coverage is issued before any benefits are paid. If coverage is denied because of a pre-existing condition, don’t give up. Instead, reapply when the waiting period is over. Elimination periods are
tion (SPD). The SPD will explain in detail all of the options and exceptions under the plan.
THE “I’s” HAVE IT When you apply for short-term disability benefits, you will be required to provide detailed medical information of your condition. If your doctor does not provide enough information to support your disability claim, or if the information is coded incorrectly, your claim may be denied. Even
of disputing medical information, get a third or fourth opinion and submit the claim again. The key is, do not quit.
TIMING IS EVERYTHING
If the illness becomes an extended one, your injury may change from short-term to long-term. Long-term disability is paid monthly and has a different set of concerns. Many claims are denied because of timing. If short-term disability ends and
qualify. This does not mean you have to be working.
Remember, insurance companies do not profit from paying claims. Each claim paid results in less profit to the insurance company and decreases their risk tolerance. However, if you have a legitimate claim, do not quit. You can receive the benefits to which you are entitled if you are willing to persevere.
Leonitta L. Turner, SPHR is Human Resources Director for Berkeley County Government. She is a member of Fresh Anointing Ministries Worship Center, COGIC under the leadership of Pastor Alvin B. Akins in Ladson, SC.
sometimes waived for medical conditions, such as pregnancy and broken bones.
Human Resource representatives may not be familiar with all of the plan exceptions. This may result in you being erroneously informed that you are not eligible for benefits. Know your plan to avoid leaving money on the table. Ask for a copy of the summary plan descrip-
if your doctor provides accurate detailed information, the insurance company may require you to see an in-house or independent physician. In-house and independent physicians do not have your best interest in mind. Their understand- ing of each case is often limited to the exam and written medical files. Also, they might not specialize in the area of illness in question. When a claim is denied because
you are considering filing for long term disability, social security disability, or social security retire- ment, file the long-term disability claim first, or your claim may denied. Long-term disability covers you when you have a condition for at least one year and can no longer work. However, many summary plan descriptions require an indi- vidual to be actively on the employer’s roster in order to
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