How to Apply for Short Term Disability in Pennsylvania

The three documents

1. Your claim form. Dates, the condition and how it stops you working. Be specific about function rather than describing how you feel.
2. The employer statement. Your job duties, earnings and last day worked. Check it, because an inaccurate job description will be used to say you can still do the role.
3. The attending physician statement. The document that decides it.

The physician statement is where claims are lost

Busy doctors complete these quickly, and a form saying “lumbar strain, off work six weeks” gives an insurer almost nothing to approve.

What it should contain:

• Objective findings, including imaging, examination results and test data.
• Specific functional restrictions: how long you can sit, stand and walk, what you can lift, and limits on reaching, gripping or concentration.
• How those restrictions prevent the specific duties of your actual job.
• The treatment plan and expected duration.

It is entirely reasonable to give your doctor a written summary of what your job physically involves. Most have no idea, and it materially improves what they write.

Timing

File as soon as you know you will be out beyond the elimination period. Late notice is a common denial reason and it is entirely avoidable. Keep a copy of everything and note the date each item was submitted and by whom.

Common avoidable mistakes

• Assuming the doctor’s office has sent the form. Confirm it.
• Describing symptoms without describing function.
• Understating limitations out of habit, particularly among people who have worked through pain for years.
• Missing continuing proof deadlines once payments begin.
• Posting about activities on social media during the claim.

If it is denied

Find the appeal deadline in the letter immediately, request the claim file and the full policy, and address the actual stated reason. If the plan is employer provided the ERISA rules probably apply, which means the record closes at the end of the internal appeal.