A short-term disability (STD) denial can feel like a gut punch, especially when you’re already dealing with a medical condition that keeps you from working. You paid your premiums, followed the process, and expected benefits to be there when you needed them most. Yet in Fort Lauderdale and across Florida, insurance companies deny valid short-term disability claims every day.
Understanding why insurers deny claims is the first step toward protecting your rights and building a stronger appeal. Below are the most common reasons short-term disability claims are denied and what you can do next.
1. “Insufficient Medical Evidence”
One of the most common reasons insurance companies deny short-term disability claims is an alleged lack of medical evidence. Insurers often argue that your medical records don’t clearly show:
- The severity of your condition
- How your condition limits your ability to work
- Why you cannot perform your specific job duties
Even if your doctor supports your claim, insurers may claim the records are too vague or incomplete.
What helps: Detailed physician statements, objective test results when available, and documentation that directly ties your condition to your work limitations.
2. Failure to Meet the Policy’s Definition of Disability
Short-term disability policies don’t simply ask whether you’re sick or injured—they apply a specific definition of disability. Many policies require proof that you cannot perform the material duties of your own occupation, not just that you are under medical care.
Insurance companies often deny claims by asserting that:
- You can still perform some job duties
- Your condition does not prevent you from working full-time
- Your job could be modified or performed in a different way
What helps: A clear comparison between your job duties and your functional limitations, supported by medical evidence.
3. Missed Deadlines or Incomplete Paperwork
Short-term disability claims are deadline-driven. Missing a filing deadline, submitting incomplete forms, or failing to respond to insurer requests can lead to an immediate denial—regardless of the validity of your condition.
Common administrative issues include:
- Late notice of claim
- Missing medical authorizations
- Incomplete employer or physician forms
What helps: Careful review of policy requirements and prompt, thorough responses to insurer requests.
4. Pre-Existing Condition Exclusions
Many short-term disability policies contain pre-existing condition exclusions. Insurers may deny claims by alleging that your condition:
- Existed before coverage began, or
- Is related to a prior medical issue
These exclusions are often applied aggressively and sometimes incorrectly.
What helps: Reviewing how the policy defines a pre-existing condition and whether the insurer’s interpretation is legally valid.
5. Surveillance, Social Media, or Independent Medical Reviews
Insurance companies may use surveillance, social media activity, or so-called “independent” medical reviews to justify denials. A brief video clip or a records-only doctor review may be used to argue that your condition isn’t as limiting as claimed.
What helps: Contextualizing surveillance, challenging biased medical reviews, and presenting consistent medical and vocational evidence.
What to Do If Your Short-Term Disability Claim Was Denied
A denial is not the end of the road but your next steps are critical. Appeals are often your only opportunity to submit additional evidence and correct the record.
An experienced Fort Lauderdale short-term disability attorney can:
- Review your policy and denial letter
- Identify weaknesses in the insurer’s reasoning
- Gather and submit compelling medical and occupational evidence
- Handle communication with the insurance company
Get Help with a Short-Term Disability Denial in Fort Lauderdale
If your short-term disability claim was denied, you don’t have to fight the insurance company alone. Martin J. Sperry, P.A. focuses exclusively on disability and insurance denials and understands the tactics insurers use to delay or deny benefits.
Call 954-324-2340 today to discuss your short-term disability denial.
Or contact us online to learn how we can help you protect your benefits and move forward with confidence.