ERISA and Equitable Tolling

In Turbville v. Metro. Life Ins. Co., 2012 U.S. Dist. LEXIS 153969 (N.D. Alabama, 10/26/2012), the District Court held: It is ‘simply illogical’ not to toll the limitations period when requiring administrative exhaustion, for otherwise, a cause of action could accrue and be immediately subject to dismissal.” Jeffries, 169 F. Supp. 2d at 1383 (quoting Mitchell, 1997 U.S. Dist. LEXIS 7323, at *5). Therefore, the statute of limitations was tolled while plaintiff exhausted her administrative remedies.”

Social Security and Long Term Disability

A common scenario in disability cases is as follows:  First, the individual files for Short Term Disability (STD) and receives those benefits for about 6 months.  If the individual continues to be disabled after 6 months (180 days), he/she may be eligible for Long Term Disability (LTD) benefits.  Assuming the individual is approved for LTD benefits, at some point in time, he/she will apply for Social Security Disability benefits.  In fact, most policies require that the disabled person file for Social Security disability benefits.  Moreover, the LTD insurer will offer to help the individual obtain Social Security disability benefits.  Why would the LTD insurer offer to help the disabled individual obtain SSDI benefits?  The answer is actually quite simple:  the LTD carrier will attempt to take a credit for any Social Security disability benefits received, and will often claim an overpayment of benefits once the individual’s SSDI benefits are approved.  Even if the disabled person does not file for SSDI, the LTD insurer will often pretend like the individual is receiving Social Security benefits, and thus, reduce the monthly LTD benefit.   If you have a SSDI claim and LTD claim, and if you hire an attorney, it may be important to ensure that the representative/attorney is able to adequately represent you on both claims.

If you would like to discuss your Social Security and/or Long Term Disability claim, please click here to obtain the author’s contact information.

LTD Exclusions

A Long Term Disability plan may contain the following “limitation” with regard to benefits:  “You are covered for 24 months of Disability . . . if you are Disabled due to a: Neuromusculoskeletal and soft tissue disorder . . . .; chronic fatigue syndrome and related conditions.”  In other words, you are ONLY covered for 2 years instead of the normal time period.  As indicated in another post, this is yet another example a limitation LTD insurers use as a basis to deny payment of claims.

If you have been denied LTD benefits, my contact information is here.

ERISA – LTD Claims

Whether or not a Long Term Disability Plan is governed by ERISA is a very important legal consideration with regard to litigating LTD claims.  There are many potentially outcome determinative legal consequences that flow from this question:  Is the plan governed by ERISA?  The type of judicial review, the right to full discovery, the right to a trial by jury, are just a few important distinctions between an ERISA and non-ERISA Plan.  Although most LTD claims that I see are governed by ERISA, it is not safe to assume that your plan is controlled by ERISA.  In addition, it is not always clear from the policy.  It may be crucial to obtain proper legal advice to determine if ERISA governs your LTD plan.

Long Term Disability Overpayments

The normal fact pattern that brings about this situation is as follows:  The claimant applies for and receives long term disability benefits.  Thereafter, the claimant receives Social Security disability benefits.  Most, if not all, long term disability (LTD) plans have a provision for offsetting the LTD benefits by the amount of Social Security disability benefits the claimant receives.  In other words, once that claimant receives Social Security disability benefits in a lump sum amount for past due benefits, the LTD carrier has an overpayment claim.  The issue is how the LTD carrier can collect the overpayment.  Obviously, the LTD carrier will ask the claimant to pay back the overpayment.  Often, the claimant will comply. If the claimant does not comply and the carrier is still paying LTD benefits, the carrier will normally stop paying monthly LTD benefits until such time as the overpayment is recovered. Basically, the carrier credits the amount owed against the overpayment balance.  Some carriers have tried other approaches, such as bringing suit under ERISA or bringing a counterclaim for reimbursement under ERISA if the claimant brings suit to challenge a decision of the carrier.  In one relatively recent case, the Court held that because the carrier could not specifically identify whether or not the claimant still had the overpayment proceeds in her possession, the LTD carrier could not recover the overpayment directly from the claimant, but instead, could withhold benefits to collect to the overpayment.  Epolito v. Prudential Ins. Co. of Am., 737 F. Supp. 2d 1364, 2010 U.S. Dist. LEXIS 91010 (M.D. Fla. 2010).

UPDATE (10/17/2012) – I have reviewed some additional favorable cases regarding this topic:

* Herman v. Metlife (M.D. Fla. 2010); Ross v. Pennsylvania Manufacturing Association Ins. Co., (S.D.W.Va. 5/22/2006) (Recovery of overpayment prohibited by 42 U.S.C. 407); See also: Mote v. Aetna (N.D. Ill. 2006); Reichert v. Liberty.

 

Disability Social Security Substitute Policy

Disability Social Security Substitute Policy benefits are usually sold as private insurance to individuals. Generally, the Policy will provide a monthly benefit for a certain number of years. Like many disability policies, the individual must be “disabled” as defined in the policy.  These policies add an additional requirement that the individual not be entitled to Social Security benefits. The Policy may also require that the individual not elect to receive retirement benefits from Social Security.
If you need help with your private disability claim and want to talk with an attorney, feel free to call my office. Click here for contact information.

Do You Need a Long Term Disability Lawyer?

f you are disabled and receiving, or not receiving, long term disability benefits, you know how frustrating the process can be.  Long term disability insurers demand a lot of information.   The paperwork can be daunting.  Physicians become agitated with the incessant questionnaires, phone calls, and requests for medical records, from the long term disability insurers.  Over the next few weeks, I’ll discuss some the difficulties involved in handling these cases.  In the meantime, if you need assistance with your claim, my contact information is found here.