My fellow disability claims analysts – how many of you can relate to this dilemma?
You’re coming up on the time when a Short Term Disability (STD) claim may need to be transitioned to Long Term Disability (LTD) per your company’s guidelines. However, you’ve got hundreds of newly submitted STD claims on your desk that are also a priority.
You’re likely asking yourself: “Is it critical to stop everything to transition that claim if there’s time left in the STD benefit period?”
Right now many disability carriers are seeing their claims analysts struggle with this exact question. Given the typical volume of STD claims seen by disability insurers, it can be challenging to manage transition periods in a timely manner.
As a result, we struggle to find the best time to transition these claims before the STD benefits are exhausted. Or, even worse, we transfer a claim to LTD in order to maintain the benefit without first ensuring the claimant is eligible.
What’s an STD Claims Analyst To Do?
Here are some questions to consider when determining the appropriate time to transition an STD claim to LTD:
- Is the claimant’s medical condition advanced or terminal?
- Is the claimant’s recovery or prognosis unknown?
- Are the claimant’s functional abilities, based on an analysis of their restrictions and limitations, precluding them from returning to work?
- Is the STD claim approved to maximum duration, and no later than six (6) weeks before the maximum duration date of the STD claim?
- Is there is no anticipated return-to-work (RTW) date?
- Is the anticipated RTW date beyond the STD maximum duration date?
The above list is fairly self-explanatory; these are some of the guidelines we must follow for transitioning STD claims as disability claims analysts. What we more often struggle with is when we have STD plans that have maximum benefit durations of between 12-16 weeks. This is when we can be caught thinking about whether to initiate the transition to LTD.
The Final Answer – It’s All About Timely Handling
Leaving more time than is technically needed for transitioning the STD claim is the smart way to go. It is especially important to transition claims in a timely fashion since the LTD investigation can be extensive. The LTD investigation may include, but is not limited to:
- Pre-existing condition investigation
- Detailed vocational analysis (i.e., employability assessment or own occupation assessment)
- Detailed assessment regarding the claimant’s long term medical prognosis and Return-to-Work (RTW) potential
- Explanation and assistance to the claimant with initial Social Security application process
Having worked in STD for most of my career, I can vouch for the importance of planning ahead so the STD claim is transitioned to LTD on a timely basis. This pays off in a number of ways such as:
- Timely and accurate LTD decisions and benefit payments
- Seamless transitions from STD to LTD
- Quality customer service through reduction of the employee’s stress during what is already a trying time
So, from the beginning of the STD claim, look to see if the employee has LTD coverage. If so, determine the transition period up front (6-8 weeks before the end of STD benefits) and set a diary task for yourself. This will help with the flow of the claim and ensure you can spend time dotting the “I”s and crossing the “T”s so the claimant doesn’t get caught in unnecessary limbo, or worse, receive a benefit they shouldn’t receive.