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Palm Beach

January 2017 Archives

A well-prepared claim and applications resulted in benefits under all of claimant's policies

The value of making sure all necessary proof of disability is obtained and clarified prior to filing a claim for disability benefits is imperative to the success of any claim, whether it is filed under a group policy, an individual policy, or multiple policies simultaneously. When filing a claim with multiple carriers, making sure the information submitted to each is well-supported and identical can be the difference between claim approval and claim denial under all policies, as most insurance companies require the claimant to identify all potential sources of disability income so they can share information.

Troiano v. Aetna Life Insurance Company

Troiano v. Aetna Life Insurance Company, No. 16-1307 (1st Cir. 2016), involved a disability insurance claimant who was approved by an ERISA Plan Administrator, Aetna, for monthly disability benefits. However, the parties disputed how benefits should be calculated. A provision within the Aetna Disability Plan allowed Aetna to offset the amount of Social Security disability income ("SSDI") benefits the claimant received from the Social Security Administration ("SSA") from the benefits Aetna paid the claimant on a monthly basis. The claimant argued that the provision only allowed Aetna to deduct the net (post-tax) amount. Aetna argued it was permitted to offset the higher, gross (pre-tax) amount. The district court ruled that Aetna's interpretation of the disability Plan language was reasonable and entitled to deference. The First Circuit Court of Appeals upheld the district court's rulings, noting that the dispute was not about whether the claimant's SSDI benefits could offset the monthly Aetna disability payments, but whether the administrator may use the higher, gross amount of the SSDI payments for offset purposes.

Liberty Mutual Changes Company Leave of Absence Policy for Employees Already Out on Leave of Absence

Liberty Mutual Insurance Company's Leave of Absence policy was recently changed to provide that "[failure to return from leave...after 24-months may result in termination of employment." As a result, many employees on an approved leave of absence because of medical disability were advised by Liberty Mutual that if they did not return to work by December 31, 2016 they would be terminated. This included long-time employees approved for disability benefits for years by Liberty Mutual, who administers and self-insures its own disability benefit plan. Liberty Mutual previously had a longstanding policy of retaining "disabled employees" and provided access to ongoing health, dental and vision insurance at employee rates for themselves and their families for as long as they remained approved for long-term disability benefits by Liberty.

Disability Insurance Law Group Successfully Overturn's MetLife's Disability Insurance Denial of Kindergarten Teacher

Ms. A became a kindergarten teacher in 2001. She loved her job and each of the children she taught throughout the years. Unfortunately, in the winter of 2014, Ms. A. was in a serious car accident. She was stopped at a light when a pick-up truck struck her car from behind going approximately 45 miles per hour. Her car was propelled into an intersection and struck by another vehicle on the driver's side. Ms. A broke her pelvis, left hip, left leg, and left arm and shoulder. She had multiple surgeries and was in the hospital for several months. She was unable to return to her class room for the rest of the school year and had to undergo physical therapy throughout the summer. Ms. A hoped to be able to return to work the following year. However, despite the surgeries and physical therapy, Ms. A remained in constant and overwhelming pain. She had difficulty walking unassisted and could not sit, stand, or walk for prolonged periods of time. Even minor activity increased her pain to intolerable levels. It became clear that Ms. A would never be able to return to the classroom. As such, Ms. A applied for long-term disability benefits under the terms of her Metropolitan Life ("MetLife") Disability Insurance Plan. After a long investigation, MetLife ultimately approved Ms. A's claim, finding that she met the definition of Total Disability as she was "unable to perform the duties of her Regular Occupation" as a kindergarten teacher. Subsequently, MetLife required Ms. A to apply for Social Security Disability Income ("SSDI") benefits and she was ultimately determined by the Social Security Administration to be unable to maintain gainful employment in any occupation. In accordance with Ms. A's MetLife policy provisions, MetLife began deducting the full amount of Ms. A's SSDI benefits and her young daughter's dependent SSDI benefits from each of Ms. A's monthly MetLife disability benefit checks and required her to pay all back benefits received from the Social Security Administration to MetLife.


Many purchase long term care insurance for peace of mind. That is the selling point of these often pricey policies and the promise made to insureds by their long term insurance carrier. Unfortunately, when an individual has gotten to the point where they struggle to take care of themselves and are forced to admit they need the benefits promised under their long term care policy, the long term care insurance company makes the process complicated, lengthy, and frustrating. The carrier's financial incentive to "slow walk" and/or deny a claim is quite strong given that the benefit under many policies may exceed $1,000.00 per week. However, there are steps that an insured and their family can take to make sure the process goes as smoothly as possible.

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