If you make a claim for short-term disability (STD) benefits, and your STD claim is denied, and your policy says that the receipt of STD benefits is a pre-requisite to receiving long-term disability (LTD) benefits, you may still have to make a separate LTD claim. If the Policy isn’t clear, or if you can’t figure it out, go ahead and make the LTD claim anyway. The downside is that it may cause some additional delay. The upside is that the insurance company may fail to properly consider your LTD claim or may make some other mistakes that will help you, should you need to initiate a lawsuit to recover benefits.
In all events, it is critical that you read your policy to understand the procedures involved in making STD and LTD claims, and appealing any and all denials before you can file a lawsuit. Under ERISA, which is the federal law governing group insurance (provided by your employer), you must exhaust your administrative remedies (meaning you must make/submit all claims and appeals spelled out in the policy) before you can file a lawsuit. If you fail to make a claim on time, or fail to appeal a denial, you may lose all rights to pursue legal action. Make sure you READ the policy and make every effort to submit your claim(s) and appeal(s) IN WRITING on time, to protect your rights.
If all this is confusing, or if you are in the midst of an insurance company battle, call us, we might be able to help. We don’t charge for basic consultations, and we like to help people.