Welcome Back…You’re Fired!
Your employer-sponsored disability insurance premiums are paid every week from your paycheck. When you need it, you expect the benefits to be available, right? Wouldn’t that be awesome if that’s the way it worked?
Unfortunately, most disability claims don’t get paid. There are exceptions and our client, Mike Smith, is one person who won his benefits despite initially being denied. Mike Smith is a fictitious name to protect his identity, but his case is very real.
For 15 years, Mike worked as an IT architect until he was severely injured in two car accidents requiring a lumbar laminectomy, physical therapies, and progressively stronger pain medications. When these medical treatments were not sufficient, a morphine pump was implanted so that Mike could continue working.
When the morphine pump created havoc in Mike’s work life – mood swings, tearfulness, uncontrollable crying, exhaustion, fatigue, and depression – Mike decided to remove the morphine pump and informed his manager the procedure required time off.
Mike returned to work on July 3rd only to be terminated. Overwhelmed, Mike sought help from his doctor, who gave him a “No work” order. Mike filed for Short-Term Disability (STD) and his employer denied his claim stating he wasn’t actively employed. It was at this point that Mike came to our office and we filed an appeal.
We proved that Mike’s employment termination wasn’t officially effective until July 4th, while his treating physician advised him to “cease work” starting on July 3rd. This date discrepancy meant that Mike met the “actively employed requirement” of the disability policy and the termination on July 3rd was an attempt by the employer to avoid their obligation under their employee benefit plan.
After presenting the facts, Mike’s employer agreed to pay full Short-Term Disability (STD) benefits followed by MetLife Insurance that also approved Mike’s Long-Term Disability payments. CASE CLOSED.
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