Short-term disability is not reviewed in the same way as LTD. Those of you who are just starting your claims may have already noticed how time intensive it is to manage a short-term disability claim. Most advocates, lawyers included, fail to realize the review abuses associated with STD until it is far too late.
The majority of insurance companies train, (if they train at all), that claims should be denied “at the earliest”. This means that all STD claims are aggressively risk managed to “get them out of here”, rather than pay the far more expensive benefits – LTD.
Anyone who has ever managed STD claims (like me) knows how complicated the review process is. Claims handlers really need training in adjudicating employer group plans, pre-existing conditions, workers’ compensation, elimination period qualification, etc. The review process is often so complicated that short-term claims often turn into long-term evaluation and LTD is payable when the STD hasn’t been paid at all. It becomes a “catch-up” cycle that some insurers and their people can’t handle ver well.
Employers always seem to make the STD process even more complicated by integrating the use of sick and PTO time with benefit payment. For example, an employee must use up all of their paid vacation time and sick pay before STD benefits begins. Some companies and/or employers may extend out the end of any elimination period in order to “pay out” sick leave and vacation time first.”
Employees (claimants) often get confused with FMLA (Federal Medical Leave Act), which is an unpaid leave that runs consecutive with STD for 12 weeks. This leave protects claimants’ jobs and benefits for only a short period of time, after which the employer can terminate employment at any time and offer COBRA.
Most claimants can get really confused about this. It is entirely likely that employees will have STD, FMLA, and state disability occurring at the same time. If there is any kind of a workplace injury, some employers actually require application for Workers’ Comp, but if the claimant does apply, STD won’t pay.
Then, there’s salary continuation and severance pay. Employers always have different criteria for this and how it may affect STD. Again, confusing to say the least.
Basically, STD is managed, or supposed to be managed, using short-term criteria. Insurers will require frequent patient notes from treatment providers, then they will pay for a few weeks followed by going out to get more records, then paying for a few weeks more. It’s a constant chase battle making sure insurers have all of the patient treatment notes on a frequent basis. Insurers won’t pay until they get updated notes every few weeks. By the way, LTD doesn’t work like this, thank goodness.
Now, combine this process with the current chaos and confusion most insurers have in place after COVID. It’s close to a nightmare, administratively.
Bottom line, claimants need to KEEP ON TOP OF PROVIDING PATIENT NOTES ON A REGULAR BASIS. Claimants won’t get paid until the next updated set of notes are sent to the insurer. STD and the transition to LTD is SUPPOSED TO BE SEAMLESS, meaning there should be no interruption of benefits transitioning to LTD. Unfortunately, claimants can’t depend on claims handlers to make this happen.
STD can be a very complicated and hassled process; however, if claimants are aware of what’s normal and what’s not, they can usually stay ahead of the process.
