A middle-aged woman lives with POTS (postural orthostatic tachycardia syndrome), a chronic condition that can cause a racing heartbeat, fatigue, and severe dizziness. When her symptoms became so debilitating that she could no longer work as a math lecturer, her doctors advised her to stop working. She filed for short-term disability benefits with MetLife.
Her claim was denied. The insurer stated that she had not provided sufficient medical proof of disability.
Like many claimants, she faced a confusing and frustrating situation. She filed an appeal for short-term disability benefits on her own while also applying for long-term disability benefits. Her long-term disability claim was approved relatively quickly, but that did not resolve her immediate financial need. She still required the short-term benefits—totaling $15,000—to cover essential expenses.
Her story was profiled in a recent article from AARP The Magazine, “Why Was Her Claim Denied?” The author reached out to financial columnist Jean Chatzky, who used her platform to help bring attention to the case.
Chatzky’s first call was to the company’s public relations department, which declined to comment on a specific claim. However, that outreach may have prompted internal review. Soon after, the woman’s case was revisited, and her benefits were paid.
Why Disability Insurance Claims Get Denied
Disability claims are frequently denied for reasons that are not always obvious to claimants. Common issues include:
- Lack of objective medical evidence
- Missing or incomplete documentation
- Failure to clearly explain how symptoms limit work ability.
- Treatment by providers who are not specialists.
- Missed deadlines.
For employer-sponsored disability plans, most claims are governed by ERISA (the Employee Retirement Income Security Act). This law places strict requirements on the appeals process. In many cases, the appeal is your only opportunity to submit evidence, and the record created during that process can determine the outcome of your case.
Short-Term vs. Long-Term Disability: What’s the Difference?
Short-term disability (STD) benefits typically cover a temporary period of disability, often lasting three to six months. Long-term disability (LTD) benefits begin after that period and may continue for years, depending on the policy.
Because these claims are reviewed separately—and sometimes by different teams—approval of long-term disability does not automatically reverse a denial of short-term benefits.
What Should You Do If Your Claim Is Denied?
If your claim is denied, there are several critical steps you should take immediately:
Review Your Policy Carefully
Get a copy of your policy from your Human Resources department. They are required to provide the version of the plan that applies to your claim. Read it closely, paying special attention to deadlines and definitions of disability.
Meet All Deadlines
Deadlines are strict and easy to miss. Some policies require notice within just a few days of when you stop working. If you are too ill to manage paperwork, it is still your responsibility—and missing a deadline can result in automatic denial.
Build Strong Medical Documentation
Seek medical care as soon as possible. If necessary, go to the emergency room or an urgent care center. Claims with self-reported symptoms will be denied. Objective medical evidence—such as bloodwork, diagnostic imaging, and clinical testing—is critical.
See the Right Specialists
While primary care physicians play an important role, insurers give greater weight to specialists. A claim supported by a neurologist, cardiologist, or other relevant expert is typically stronger than one supported solely by a general practitioner.
Understand How Treatment Choices Affect Your Claim
If you are receiving care from alternative medicine providers, be aware that insurers will not give the same weight to those records. This does not mean you should stop treatment, but you should also ensure that a qualified medical specialist is documenting your condition.
Keep a Symptom Journal
Maintain a detailed, consistent record of your symptoms. Document how your condition affects your ability to perform specific job duties. For example, if you experience vertigo, note your inability to sit at a computer or stand for extended periods.
Ensure Your Doctor Documents Functional Limitations
A diagnosis alone is not enough. Your doctor must clearly explain what you cannot do because of your condition. Review their statements to ensure they accurately reflect your limitations.
What Happens After Approval?
Even after approval, the process does not end. Long-term disability insurers often require ongoing updates and may monitor your activities. This can include reviewing medical visits, daily activities, and even social media for inconsistencies.
When to Seek Help
Disability claims can be difficult to navigate alone, especially under ERISA rules where the stakes are high and the process is unforgiving. Insurance companies are businesses, and minimizing payouts improves their bottom line.
In this case, advocacy made the difference. Once attention by a nationally known financial journalist was brought to the claim, it was reconsidered and paid.
If your claim has been denied, you may choose to seek public advocacy—or you may want to speak with a professional who understands how to build a strong administrative record and hold insurers accountable.
The reality is simple: the cost of a mistake in a disability claim can be significant, and the window to fix it is limited.
