If you experience an injury or illness that requires you to remain off work, you may be entitled to short-term disability benefits from your employer. Many short-term disability benefit plans require you to be unable to perform your usual and customary occupation. It’s important to know what benefits are available to you before you need to rely on them. You can request your short-term disability benefit plan information from your HR department or the Plan Administrator of the company’s benefit plans. 

At Roberts Disability Law, P.C., we can help you find exactly what information you need to know about your employer’s short-term disability plan. Reach out to our team today to schedule a consultation.

Who We Help

There are many situations where you may qualify for short-term disability. Our team will listen to you, help you determine next steps, and advocate for you every step of the way. Here are a few situations we commonly handle:

• Your claim was denied during recovery. You recently stopped working because of an illness, injury, or surgery, and you expected short-term disability benefits to cover you while you healed. Instead, the insurer formally denied the claim, even though your doctor has not cleared you to return to your regular job.
• Your claim is stuck while wages have stopped. You stopped working for a temporary medical condition, but the insurer has not decided your claim while it waits for forms, records, or information from your providers. Your normal paychecks have already ended, and you need an answer while you are still within the expected recovery period.
• Your benefits were cut off too soon. The insurer approved your short-term disability benefits for part of your recovery, then refused to continue them through the additional time your doctor says you need away from work. You are still within the plan’s short-term benefit period, and you have not been cleared to resume your regular job.

If any of these sound like your situation, you have options, and you do not have to sort them out alone. The team at Roberts Disability Law, P.C. is ready to take your call and schedule a consultation.

How the Short-Term Disability Process Works in California

Short-term disability in California can come from a few different sources, and the rules depend on which type of coverage you have. Understanding where your claim comes from helps explain why insurers act the way they do. Consider the following:

• State Disability Insurance (SDI). California runs a state program that pays partial wage replacement to eligible workers with a temporary, non-work-related medical condition. Deductions from your paychecks fund this program, and the state’s Employment Development Department (EDD) processes these claims.
• Employer-sponsored group plans. Many people get short-term disability through their employer. These plans are often governed by a federal law called ERISA, which sets strict rules and deadlines for filing claims and appealing denials.
• Private individual policies. Some workers buy their own short-term disability coverage directly from an insurer.

A typical short-term disability claim moves through these general stages:

1. You stop working because of a qualifying medical condition and report it to your employer, the EDD, or your insurer.
2. You file a claim and submit medical documentation, along with any forms the plan requires from your treating providers.
3. The insurer or agency reviews your medical records, work restrictions, and eligibility.
4. A decision is issued. Your claim may be approved, denied, or approved for a limited period.
5. You appeal if needed. If your claim is denied or cut short, you generally have the right to challenge that decision, often within a firm deadline.

If you receive a short-term disability benefit claim denial, you must submit an appeal in order to pursue your claim further. If you miss the deadline to appeal, you may completely lose your opportunity to reopen your claim or file a lawsuit in court. Sometimes, you must receive the full amount of short-term disability benefits in order to receive benefits under your employer’s long-term disability benefit plan. Our team can help you decide what comes next.

Why Choose Us

When you receive the denial of short-term disability benefits letter, you should contact the team at Roberts Disability Law, P.C. as soon as possible. We have represented numerous clients in their appeals for short-term disability benefits. We have also helped clients with denied claims for short-term disability benefits eventually obtain long-term disability benefits. Here’s why California residents choose our team:

• Disability claims are what we do. We have spent our careers representing people against disability insurers, so we understand the tactics they use to deny and delay legitimate claims.
• We build a strong record. Insurers decide many claims based on paperwork, so we work to gather the right medical evidence, provider statements, and documentation to support your case.
• We keep communication open. You will hear from us in language you can actually understand, and we will explain what each step means for you.
• We handle the back-and-forth. From talking with the insurer to preparing your appeal, we take that weight off your plate while you concentrate on your health.
• We have a track record clients trust. Our results and client relationships reflect the care we put into every case.

The terms of a short-term disability plan will vary from employer to employer. This is why you need to review the written plan document to find out what you need to prove eligibility for benefits. The plan document will also inform you of any exclusions and limitations that may impact your claim. With a team like ours at Roberts Disability Law, P.C., so we can guide you through the process. 

Talk to Roberts Disability Law, P.C.

The team at Roberts Disability Law, P.C. understands the ERISA short-term disability claims and appeals process. We have successfully represented hundreds of clients in their claims for disability benefits. The appeal of a disability benefit denial is one of the most important components of a claim, and we have the expertise to prepare a strong case for you.

FAQs About Short-Term Disability in California