Short-Term Disability Lawyers in California

Many Californians assume that their short-term disability benefits are automatically paid once a claim is filed. Unfortunately, that is far from reality. Many such claims are denied. When you get sick or injured, you rely on these short-term benefits to help you and your family survive during an illness or injury that will not require a long-term recovery. You are a hard worker, and you have no intention of relying on disability benefits for a long time. You just want your disability insurer to pay you the disability benefits to which you are entitled.

The McKennon Law Group PC has a history of championing for policyholder rights. We are here to help you file your short-term disability insurance claim or guide you through the appeals or litigation process. Our firm has over 7 decades of legal experience handling disability insurance claims and litigation. If your short-term disability claim is denied, you have options. Call 949-504-5381 to schedule a free consultation with a California short-term disability attorney.

What is Short-Term Disability Insurance?

Short-Term Disability Insurance (STD) is a type of income protection insurance that provides a portion of your salary if you are temporarily unable to work due to an illness, injury, or medical condition. This includes things like recovering from surgery, a serious illness, pregnancy and childbirth, or even mental health conditions like anxiety or depression. This type of coverage is typically offered through an employer or purchased privately.

Coverage usually begins after a short waiting period (often 7–14 days) and can last anywhere from a few weeks to up to 12 months, depending on the policy. Benefits typically replace about 70% to 100% of your income during the disability period. Having short-term disability insurance is important because most people do not have the savings to cover several weeks or months without a paycheck. Even a temporary loss of income can make it difficult to pay rent or a mortgage, cover medical bills, or handle everyday expenses. STD insurance provides a financial safety net, helping you maintain financial stability and focus on recovery, rather than worrying about how to make ends meet.

Who Is Eligible for California Short-Term Disability Insurance?

Eligibility for Short-Term Disability Insurance (STD) depends on whether you are getting coverage through an employer-sponsored group plan or buying it privately. For group STD insurance, most full-time employees are eligible, especially if the employer offers it as part of the benefits package. Some plans may require you to work a minimum number of hours per week or be employed for a certain period—like 30 or 90 days—before you are eligible to enroll. Part-time, temporary, or seasonal workers often are not eligible under group plans. Enrollment usually happens during open enrollment periods, but you might also qualify during a new hire window or after a qualifying life event.

If you are buying individual (private) STD insurance, you are typically eligible if you are:

Between the ages of 18 and 65
Actively working at least 30 hours per week
In reasonably good health (you may have to undergo medical underwriting)
Not currently disabled or receiving disability benefits

Private STD insurance is a good option if your employer does not offer coverage or if you are self-employed. It gives you more control over the benefit amount, elimination period, and length of coverage.

Why Would a Claim Be Denied?

There are certain things that will get a claim denied that you should be aware of. Some of the most common reasons a claim will be denied include:

Insufficient medical documentation: Your doctor must provide medical details outlining your short-term disability. If they don’t provide enough information or they don’t certify your condition, your claim will be denied.
Inconsistent medical records: If you have multiple providers and they submit conflicting reports, it will immediately raise red flags.
Not following your treatment plan: If you fail to follow your treatment plan as ordered by your doctor or you miss follow-ups, your claim could be denied or even canceled if you were already approved.
Pre-existing condition exclusions: Many policies do not cover disabilities caused by a condition you were diagnosed with or treated for before your coverage began, usually within a specific “look-back” period (often 3–12 months).
Insufficient work history or ineligible job status: If you haven’t worked long enough, don’t meet the minimum hour requirements, or were classified as part-time or a contractor, your claim may be denied.
Lack of objective evidence: Some insurers require objective medical findings—like imaging, lab results, or formal evaluations. Claims based mostly on subjective symptoms (e.g., pain, fatigue, or anxiety) can be harder to prove.
Engaging in disqualifying activities: If the insurer discovers that you are working another job, participating in physically demanding activities, or engaging in anything that contradicts your claimed disability, the claim can be denied or terminated.
Waiting period not met: If you submit your claim before the required elimination period (the number of days you must be out of work before benefits begin), it may be automatically denied.
Paperwork or claim form errors: Even minor errors or missing sections on your claim forms, physician statements, or employer documentation can cause a delay or outright denial.

Getting your questions answered by an attorney experienced with California’s short-term disability process can help determine whether or not you qualify.

How Do Private STD Claims Differ From ERISASTD Claims?

Privately purchased insurance plans are governed by California state contract laws and offer a wide range of remedial compensation and legal options. However, if your policy is provided by your employer, then it will be governed by the Employee Retirement Income Security Act(ERISA). ERISA limits your legal options and legal remedies when dealing with denied short-term insurance claims.

The duration of STD policies is often between 3 to 12 months and may transition into long-term disability coverage. The claim process begins when you file a claim with your insurer and provide them with medical records, employment information, and physician statements.

If your claim is denied, your options will vary depending on how you acquired your short-term disability insurance. Again, those who privately purchase their policy have more legal options available to them, including:

The ability to immediately file a lawsuit instead of having to exhaust the insurance company’s internal appeals process.
The right to a jury trial in California state court.
You can sue the insurance company for bad faith denials, including punitive damages and consequential damages.
You can recover your attorney’s fees and costs in the lawsuit.
You have a right to collect interest that has accrued on wrongfully denied claims.

Appealing a denied claim that you acquired through your employer is far different, and your legal options are more limited. ERISA does not allow you to sue for punitive or consequential damages, only the denied benefits, attorney’s fees and costs, and interest. ERISA claims are also only heard by a federal judge; you cannot have your appeal heard by the state court or a jury. You also have a limited time to submit evidence; missing this window can be detrimental to your case. Perhaps one of the biggest hurdles you have to clear is that ERISA requires you to exhaust the insurance company’s internal appeals process before you can file a lawsuit. This period is 180 days from your receipt of the denial of your claim.

Under ERISA, if your insurance company has a discretionary authority clause as part of your policy, a court will give substantial deference to the decision it reached when determining if a claim is approved or denied. This discretion and standard of review makes it more difficult to prevail against your insurance company. Some jurisdictions prohibit these discretionary clauses.

It is important to have a short-term disability benefits attorney on your side when applying for benefits or appealing a denial.

How Can McKennon Law Group PC Help?

When it comes to short-term disability benefits, there are many legal pitfalls, deadlines, and loopholes to look out for. Getting tripped up at any stage of your claim can result in your claim being denied. Even worse, it can result in your appeal also being denied and you losing the ability to get your benefits entirely.

When you work with a short-term disability benefits attorney with McKennan Law Group PC, you work with a team with more than 70 years of experience handling disability insurance claims. If you have questions about your claim or you need help appealing a denied disability claim, call 949-504-5381 to schedule a free consultation with our team.