Individuals in Chicago who have long-term disability claims frequently are told by the insurer they will not be considered for long-term disability until they have exhausted short-term disability. That sounds logical, but what happens when the insurer or administrator denies your short-term disability claim? The insurer expects you to appeal the short-term disability, and only if after that appeal it agrees you are disabled, then it will consider a long-term disability claim. This aggravates the delay in payment problem for many individuals. It is even worse if you have to invoke ERISA § 502(a) litigation on a short-term disability claim before even getting to the issue of long-term disability. Nobody wants to spend a year or more in court just to start the long-term disability inquiry. Sometimes individuals, and their lawyers, try to make a clever argument to bypass the need to make a long-term disability claim for this very reason.
In a recent case, Haggerty v. Metropolitan Life Insurance Company, No. 19-cv-1067, 2021 WL 243037 (W.D. Pa. Jan. 25, 2021), Haggerty worked at G4S Investigations as an investigator related to, ironically enough, disability insurance and worker’s compensation claims. He made a claim for short-term disability benefits, and MetLife, acting as the third party claims reviewer, denied the claim and upheld it on appeal. The long-term disability insurance policy required a claimant submit a claim within 90 days of the end of the elimination period (which is the waiting time to commence long-term disability payments, and typically coincides with the duration of short-term disability benefit availability). But Haggerty never did submit the claim. Instead, he tried arguing in court that MetLife misled him into not filing the claim. The court was not sympathetic, and held not only did Haggerty not initiate the claim on time, but that caused his claim to be lost.
What everybody can learn from Haggerty’s case is that even if your short-term disability claim is denied, if you are going to be on disability into the long-term disability period, press the insurer to open the long-term disability claim. It is far better to fight both claims at the same time if it goes to court, then never have submitted a claim and risk losing the benefits. If your short-term disability case is denied, and you know it’s a long-term disability, get help from an ERISA long-term disability lawyer.
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