Employees, Executives and even partners of businesses in Chicago and the Midwest may be surprised to find out what exactly they need to do in order to qualify for disability benefits from an employer provided long-term disability plan even in seemingly clear cases of disability. There often are requirements of how quickly you must make a claim for benefits and how long thereafter you have to file a lawsuit regarding any denial of benefits. These time limitations and all other claims procedures are always outlined in the plan documents. However, you may have never looked at the plan documents. Admittedly, even this author has once been covered by an ERISA disability plan and not read the plan documents!
If you become disabled, however, the terms of that plan and the claims procedure will become immensely important. Recently, a disabled worker in Louisiana learned this lesson the hard way. Connie White qualified for short-term disability. Upon exhaustion of the short-term disability benefits, she applied for long-term disability benefits submitting records from her physician indicating she could not work. Her claim was denied, and in the denial letter the administrator, Metropolitan Life Insurance Company, cited a lack of required medical evidence. Ms. White thereafter submitted the additional medical evidence. Met Life, however, upheld its earlier denial and advised Ms. White’s lawyer that she had not submitted proof of filing a claim for Social Security disability benefits–a requirement under the plan.
Ms. White applied for Social Security disability benefits, was initially denied, but successfully appealed that denial, being awarded over $56,000 in past due benefits by the Social Security Administration. Thereafter, she submitted evidence of the award of Social Security disability benefits to the administrator, but to no avail. When Ms. White sued Met Life, Met Life moved to dismiss the complaint and for summary judgment. The Court dismissed the claim because the plan required that no legal action could be filed “more than three years after the proof of Disability must be filed.” White v. Metropolitan Life Insurance Co., No. 10-30707, 2011 U.S. App. LEXIS 3682, at *3 (5th Cir. Feb. 25, 2011). Ms. White’s delay in this case, reasons for which are unknown and not readily apparent from the record in that case, very likely cost her the benefits. Whatever Ms. White’s reasons were for delay, one thing is clear: if you are disabled, immediately speak to a lawyer knowledgeable about ERISA and familiar with plan documents.