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Can a long-term disability insurance company claim an overpayment once a claimant is approved for social security disability income benefits?


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Social Security Disability Offsets in Disability Insurance Claims

Most group long-term disability policies contain a deductible source of income provision. It is very rare to see an individual long-term disability policy with a social security offset. A deductible source of income is also known as an offset.

Social Security Disability Income benefits (SSDI) are almost always considered a deductible source of income. SSDI is only one type of deductible source of income commonly found in group long-term disability policies. If a disability carrier has been paying you long-term disability benefits for 20 months and you get awarded SSDI benefits which are retroactive to 15 months prior, then your disability carrier will claim that you were overpaid for 15 of the past 20 months and you must pay the retroactive SSDI award to your long-term disability carrier. In addition, each month moving forward, your disability carrier will reduce your monthly benefit amount by the amount of your monthly SSDI check.

For example, if SSDI is paying you $1,600 a month and your disability carrier was previously paying you $3,000 a month, then your long disability carrier will now only pay $1,400 a month. Essentially the United States government just saved the disability insurance company $1,600 a month.

I generally tell clients that are approved for SSDI not to spend their retroactive award of disability benefits as their disability carrier will be asking them to turn over the full amount.

There are 536 opinions so far. Add your comment now.

Sharon Campbell:

I need your help. I am disabled. I pull my retirement ’cause I was suffering with bills the company fired me and my company did not pay into social security so I had to go on their long term disability. Now I pull this retirement 2 years a little after they had approved me for the the long term disability. This was done in 2008. Now I have recieved a letter form them stating that I was supposed to let them know. This is my money that I worked hard for so can you let me know what you can do for me. Thank you, Sharon.

Attorney Greg Dell:

Sharon, you need to check the language in your long term disability policy and see if retirement income is a deductible source of income. If the disability company is looking to offset your disability benefit by the amount of your retirement distribution and you want to tell them they can only offset one month’s benefit check and not the entire amount of the retirement distribution.

Josephine Ortiz:

I was a Geogia State Employee and became disabled and I was receiving long term disability from the Standard when Social Security approved me for SSDI. Now the standard claims and overpayment and wants to be reimbursed 15,000.00. Why do I have to repay them if my LTD premium was deducted biweekly from my salary. Additionally, I find no legal authority which requires repayment…

Attorney Greg Dell:

Josephine, most ERISA governed long term disability policy contain language stating that SSDI benefits are a deductible source of income. You need to check your disability policy to see if The Standard is entitled to an offset for SSDI benefits.

Judy:

I have a different kind of problem going on, my doctors office completed a FCE wrong, the secretary who filled it out did not put my restrictions on the form basicly saying i can return to work and my doctor signed the form and it got sent to Hartford I have been on disabilty with Hartford for 3 years also collecting SSD. My doctor is willing to write a letter to Hartford to explain my restrictions my question is are they going to accept it since he signed the FCE with the wrong information. Thanks for your help.

Attorney Greg Dell:

Judy, you doctor can certainly send a clarification letter to Hartford and it would be a good idea to have him do so. Please make sure he is specific about any of the mistakes that were made. This should be done ASAP.

Carla Mcvay:

What happens if I dont send (company paid) LTD the overpayment from social security disability? My paperwork reads: “It will reduce to minimum amount required by law, and referral to collections till paid.” Can they guarnish my disability? I’m afraid once they receive the “overpayment” they will find a way to cut me off & I will lose my home, due to less income. I can pay off home with backpay.

Attorney Greg Dell:

Carla, they can garnish your future disability payments and they could try to sue you for the overpayment benefits they are claiming. There is no guarantee that they will continue to pay you once you send them the overpayment money.

Mike Moen:

Help. I went on Long term disability because of Kidney failure in 2005. I stopped working and started receiving benefits from Metlife in November of 2005. In 2010 I received an award for a class action lawsuit unrelated to my disability, I opted in as a class menber in 2006 for Wells Fargo OT class action Lawsuit.

My share of the award was detemined to be from 2/2001 to 10/31/2005 based on the number of weeks worked. When I received the check the law firm stated that 1/2 of the settlement award must be treated as “back wages” and the other 1/2 as “Liquidated Damages”.

Can MetLife offset my benefits by this income? My LTD plan has a provision for deducting amount of income stating: The gross LTD benefit will be automatically reduced by the amount of income you are eligible to receive from other sources, including but not limited to:

Further down the list it states:

Third party recovery for loss of income by judgement, settlement or otherwise, including recovery amounts you may receive from future earnings.

Can they claim an “Overpayment” and request that I reimburse them these funds?

Thanks,
Mike from Minnesota

Attorney Greg Dell:

Mike, without seeing your policy it is difficult to answer your question. Generally, if income is for services provided prior to disability, then it should not be deductible. You should maintain copies of all documentation clarifying the time period for which the payments covers.

David Margolias:

I have a general question that you may know the answer to. My wife has MS and has been on LTD since 1986 from a policy provided by her former employer (Northrop). She also receives SSI and, of course, the insurer (MetLife) reduces her disability payments each moth by the amount she receives from SSI. Yesterday we were called by MetLife saying they made a mistake in their initial calculations (15 years ago) of their monthly payments to us by $8/month, and they want us to return 15 years worth of claimed overpayments ($1,440). First, can they do this (since it was their error), and second, can they go back 15 years worth? Even the IRS allows one to go back no more than 3 years. Also, they have never applied COLA to their payments, unlike SSI. Do they have to?

Attorney Greg Dell:

David, I have seen thousands of overpayment request, but I have never seen a company go back 15 years. My impression is that it would be unlawful for MetLife to seek an overpayment do to a mistake they made 15 years ago. I think that worse case scenario that MetLife is limited to the statute of limitations in your state or the limitations clause on all claims in your wife’s policy. The statute of limitation for claims varies in every state but is never longer than 6 years. The policy may limit all claims to three years and this could be argued to apply to your wife’s claim as well. You should ask MetLife to provide you with the legal basis they are relying upon in order to seek payments from 15 years ago. I would tell them that they are estopped from collecting an overpayment from 15 years and that the statute of limitations for them to claim a 15 year overpayment has been exhausted. Certainly if your wife had waited 15 years to make her claim for benefits, then they would have denied the claim. You have to right to file an Appeal with MetLife if they don’t agree with you the first time. I don’t have the exact answer and I have never seen this issue before. This repsonse is my opinion and should not be construed as legal advise as you are not my client. I am required to give you this disclaimer so that you do not rely on my opinions. I wish you luck.

Linda Kelley:

I have the same concerns as several of the blogs above. In my case Lincoln Financial is the LTD Insurance carrier. They have done countless, less than honest practices managing my benefit payments. Blatant “slow walking” or with holding of benefits, failure to disclose requirements neccessary for continued benefits, un-accessible representatives available for assistance regarding benefits and more have been the nightmare I have had to endure. The compounded stress for the last five years has seriously affected my health, well being, recovery and state of mind. I feel as though I live in terror. One example: I did not recieve my benefit payment for three months. I was not given a reason for the interruption of my funds? I kept explicit documentation of the daily calls and faxes to my representative of my attempts to resolve the matter with no success. When I was finally contacted I was apologized to and it was explained to me that she had gone out on maternity leave and forgot to set up my scheduled payments. Do you have any understanding what that does?

It tears a person down and belittles them. The mismanagement of funds took away the position of being empowered and able to manage my own life. I didn’t know how I was going to pay my mortgage, my utilies were in jeopardy of shut off, I had no money to buy food or keep a scheduled doctors appointments, in short I could not be sure I could maintain the basic daily living standard. I had no money to even purchase perscribed medication. I spent most of my life working hard. I am a productive member of my community. I deserve to be treated fairly. When our major institutions are allowed to employ decietful practices as the ones I have experienced with Lincoln Financial it is easy to understand why we are angry. Why should we play by the rules when the rules don’t apply to everyone.

I relate with Carla, above, they have tried several different ways to discontinue my policy. You know that if you give them back pay from SSD it will only be a short time before there is another reason to with hold benefits. I feel they should be responsible for the improper disclosure and with holding of funds which resulted in serious damage to my credit rating as I literally had no available money to keep my financial obligations current.

I have two daughters graduating college this May 2011, one from Palomar’s R.N. Program and the other from Madera State Center Co. College and accepted to Loma Linda’s P.T. Program. My son served in the U.S. Navy and was a Navy Seal Sharp Shooter. My mother is a Lt. Colonol in the U.S. Army. I come from a strong hard working family. I don’t know how to tell anyone I will not be able to pay rent next month. I am terrified and have no idea of what I am going to do. I will be homeless, unable to maintain insurance for my vehicle or pay fees, unable to pay for medical exams neccessary to continue policy coverage. They have finally managed to back me into a corner. I have a policy that pays me until I am 65 years old, worth approximately $300,000.00 yet I face these circumstances next month.

Susan Whitehurst:

Can the Long term disability company, in any way, get the Social Security Disability people, to send them my back payment? Or will SSDI only send the back payments to the disabled person?

Also, I am being “assisted” by Genex… they have asked from SSDI a “representative payee information”. From what I am reading it is a request to be paid for services. I was told by UNUM that if I used Genex there was no cost. If I am not getting the rason that Genex asked for this information, what othr reason would they have to what the payee information?

Thanks,
Susan

Attorney Greg Dell:

Susan, it is our understanding that SSDI benefits can only be sent to you and not your disability insurance company. I have seen situations where SSDI benefits are withheld for child support. If you are approved for SSDI you will have an overpayment and probably owe the entire award to UNUM. The government will pay up to $6,000 of attorney fees for an SSDI attorney. Unum will deduct the award of any attorney fee from any overpayment. So, if Genex gets an award of attorney fees it is not costing you anything because the $6,000 paid to Genex from your SSDI benefits would have gone to UNUM anyhow.

Douglas Odom:

I started receiving long term disability payments for bi-polar disorder in February, 2009. They continued on until February, 2011 and then stopped because The Hartford only pays mental health disability for 24 months. They had me file for SSDI with a law firm they recommended. Even though I am no longer getting LTD payments, the law firm is still representing me to try and get me on SSDI. I asked them if I would still have to pay The Hartford back and they said yes. This doesn’t seem right to me since The Hartford is no longer paying me LTD payments. Is it legal for them to demand I pay them back even though they aren’t paying me anymore? Keep in mind, I haven’t been approved yet for SSDI. Thanks!

Attorney Greg Dell:

Douglas, your question is challenging. Hartford’s contract may give them the right to seek the funds, but their are some cases around the country that suggest that a disability carrier may not be entitled to receive the funds that have been overpaid. I have discussed some cases on this site so you should do a search with the terms overpayment and also SSDI overpayment. You may not need to pay any money back to Hartford in your situation. Since I am not your attorney I can not give you any legal advice at this time. You may want to contact us if you are approved for SSDI and Hartford seeks an overpayment.

Brian Loreti:

I have a situation where the group carrier not only claimed an overpayment for the SSDI received by my client, but also claimed as part of that overpayment the amount of the SSDI child benefit received by his minor daughter. Is this usually considered normal offset provision as well?

Attorney Greg Dell:

Brian, the situation you have described is unfortunately normal.

Robert:

Due to Aids/bipolar 1 disorder. suicide attempts, chronic diarrhea, frequent Migraines, as well as frequent nausea and Seritonin Syndrome, I was advised by both of my doctors to apply for SSDI since I was not able to work and they both felt I was not going to return to work. I recently received my approval for SSDI, which I will only bet back pay after a since month period due to there rules, Through Gentiva Home Health I received Short term disability through December then I was approve for LTD. I called them and my Doctors office sent a letter from the approval letter of the SSDI, then I also called met life and spoke to a “representative”, since they will not let you talk to the case manager, God forbid one of them is disterb, I was told that I would have the long term disability deducted from my SSDI benefit, which will leave me $50 dollars a month to live on, so I have to canceled Cobra, $480.00 a month and I will be able to pay me mortgage payment, not to mention food, utilities, etc. I think this a poor benefit just putting off the enevital forclosure and not insurance and living on the street, hopefully I can find a tree here in AZ since it gets over 100 degrees in the summer. So I also want to know if they take your STD payments back as well, there is no mention of this in the employee handbook, all it says is that we have a ST benefit and a LT benefit, pretty sneeky I think. Any information would be helpful and soon before my electricity is turned off. Thanks, Rob.

Attorney Greg Dell:

Rob, most Short Term disability insurance policies don’t have setoff provisions for social security disability benefits. However, you need to review the terms of your Short Term disability policy.

John:

Greg, I have a private, own occupation, non-erisa policy until 65 (40 now) that pays over $5000.00 a month and am receiving benefits for PTSD, anxiety, and depression (Iraq war veteran). I also receive 100% permanent and total disability from the VA and SSDI for the same conditions. From time to time, I get harrassed by insurer for psychotherapy notes (we refuse to provide them) and more independent medical exams. I have two questions:

First, is it likely that they will attempt to terminate my benefits now that I am receiving VA disability and SSDI? I thought those were much harder benefits to get than benefits from an own-occupation policy.

Second, is it wise to retain an attorney to shield myself from the nonsense and intimidation of the insurance carrier?

Please advise, thanks.

Attorney Greg Dell:

John, the disability carrier could deny your claim for failure to provide medical records. VA and SSDI can be more difficult to obtain in some states, but approval of these two government benefits is not binding on your disability company. You should watch our video on monthly claim handling to learn about the advantages of having an attorney assist you with your claim.

Kristina Snyder:

Gregory,

My husband has been receiving Long Term Disability pay from Lincoln Financial since March of 2007 in the amount of $2016.00 a month. In December of 2010 he was awarded Social Security in the amount of $1138.00 a month a we received back pay of approx. $6000.00. Knowing that the backpay would go to Lincoln, I have held this money aside for their payment.

When he was awarded Social Security, we contacted Lincoln and they reduced thier payment to offset the amount he is receiving. At that time, he also asked for the amount we owed them so we could quickly get it resolved (I hate owing money!). He faxed over the award letter with the backpay amount we received to help them calculate what was owed.

Finally 6 months later he has received a letter from Lincoln demanding payment of $39,000.000 in the next 30 days. This to me seems obviously wrong but when he called to let them know they told him that he was eligible for dependant pay of $550.00 a month (that we are not receiving) and they are asking to be payed back to March of 2009.

Is it even possible that we owe them money we never received from Social Security? Please take a look at this scenario and tell me what I’m missing.

Attorney Greg Dell:

Kristina, I am aware that some disability carriers will claim an offset even though the claimant has not received the funds. The problem is that some policies contain language that allow the disability company to estimate the amount of a setoff. If you write a letter and tell Lincoln Financial that you have not received any funds beyond those that you have sent them, then they should resume paying the full benefits.

Bonnie Kennedy:

I was approved for Social Security Disability and as expected MetLife is asking for an overpayment of funds they paid me on my LTD I had through my employer. My question is can MetLife ask for my children’s retroactive payments that were sent to me by social security? I have asked this question two times to Metlife and cannot get a straight answer from them. To date I have only been asked for MY retroactive payments not the kids’ but I am afraid to use the money to help with college bills for the kids only to have MetLife come back and ask for it.

Attorney Greg Dell:

Bonnie, your question does not have a concrete answer. Please see Can a disability insurance company claim an overpayment for social security disability benefits payable to a child as result of the parent’s disability? for more information that may be helpful.

Thomas Glandon:

I was hurt and started to get short term disability from an insurance policy from my job, now thay started me on long term disability. Can I get my social security and the long term at the same time?

Attorney Greg Dell:

Thomas, the answer to your question depends on the language in your long term disability policy. If you have a group disability policy provided by your employer, then your disability policy probably does not allow you to receive ssdi and Long term disability at the same time. You want to look at the deductible sources of income section of your policy.

Disabled in Texas:

My husband had a serious wreck in April 2010. Has LTD through his employer through CIGNA. His employer hired a company to help him get on SS Disability. Within the last week husband was approved Medically with a onset date of the accident, but non-medically approved him a year from the date of accident, April 2011. After reading all the information above now I wonder if we should appeal his case or accept the approval of benefits with the effective date of April 2011? That way we shouldn’t have to pay back CIGNA anything, correct? My assumption is that CIGNA would stop the LTD effective October 2011, correct? We live in the state of Texas and from what I understand SSDI benefits will not begin till October 2011, 5 months after the approval date of the onset of SSDI benefits. I would love to hear your thoughts and suggestions! Thanks!!

James:

I have received ERISA Short Term Disability that has now ended; my LTD claim is now on hold for review. I have since requested and received a total withdrawn of my 401k pension, I still have the check. Will the insurance company be entitled to my pension for pass STD received or future LTD if my claim is rewarded?

Attorney Greg Dell:

Disabled in Texas: If the Cigna date of disability is April 2010, then Cigna would seek reimbursement for any SSDI benefits paid back to that date. Cigna may require you to appeal the SSDI denial, but you are correct that is does nothing but benefit Cigna. A back date of SSDI may help your husband get medicare sooner. I am not an SSDI attorney so I don’t know about medicare approval. If your husband is still unable to work, them Cigna and SSDI should continue to pay. If you need assistance please contact us.

Attorney Greg Dell:

James, unfortunately we cannot answer your question without reviewing your policy. I have seen many disability policies that consider 401k pension to be a deductible source of income.

Floknoes:

Hello,

I have been paid by my LTD company, The Standard, since I became disabled 11/2008. Social Security has just approved my claim back to 12/2008. My LTD company didn’t start paying until my STD plan ran out in 1/2009. I was contacted by the SSA today. They advised me that I have been approved and that the $45k back payment they owe me will be deposited and that I would need to transfer that over to my LTD company. That’s fine. Then they said that they are also retro paying me for my children to the sum of $23k. I asked SSA if I need to sent the $23k to my LTD company and they told me no, that the LTD company does not have a right to my children’s money, only to my money. My policy states that any “deductible income” will be considered. Then it talks about full offset, primary offset and partial dependents offset. It doesn’t tell me which one applies to me? It is very confusing! Are they entitled to the backpay for my children? Are they entitled to future benefits paid to my children? What’s your opinion? I would appreciate any information you can give me. I live in the state of Florida. Thanks!

Attorney Greg Dell:

Floknoes,

The answer depends on the language of your policy. Please see the following frequently asked question which may help answer your question of child social security disability benefits: Can a disability insurance company claim an overpayment for social security disability benefits payable to a child as result of the parent’s disability?

Lucy:

Disability, not much left to live for. Finally got my SSD, now I finally have a little money I could use to fix some things and pay some bills but have to turn it over to Met so OK. I was told they would pay me a certain amount when this was over and now they changed their minds, so even less money!!! Oh goodie, this means I get to move again, all these years protecting the public, proud of what I did, washed up with siezures two years ago, other medical problems that won’t go away and it’s all over, not what I planned for at 53. Food boxes, bread lines, free farmer’s markets, no one comes around and it’s not my attitude, I am just not in the loop anymore, and I am broke all the time plus the meds. I keep telling myself this will get better but alll it does it gets worse.

Kadee:

I’m currently on longterm disability and MetLife has given me the run around and cut me off for months even though my medical documentation supported my disability claim and was reinstated upon appeal. I’m wondering if approved for social security for fibromyalgia if MetLife requires that I have to pay back everything over the 100% allowed of predisability earnings or if I am required to send entire monthly them amount received for each month from social security?

Attorney Greg Dell:

Kadee,

In most group disability insurance policies if you are approved for ssdi, then the disability carrier will seek the entire ssdi disability award as a repayment. The amount sought will be to offset any disability benefits that the disability carrier has paid the claimant.

Lottie Taylor:

I was receiving ltd from Prudential. I also applied for widow’s ss disability. You see, I am a widow, my husband died in 2004. I became disabled in 2010. Now my long term disability company wants me to pay back money I received from my widow’s disability that I was receiving since January of 2011. Can they do this? I thought when it’s a widow’s disability they could not do this. They are claiming I owe over $7000.00. Do you have any insight on this kind of situation. I appreciate any feedback. Thanks so much.

Attorney Greg Dell:

Lottie,

We would need to review the exact language of your disability policy in order to determine if Prudential is entitled to a setoff for widow social security disability benefits. In most cases the disability carrier is not entitled to a setoff for the widow benefits. You should write to Prudential and explain the situation. Additionally, you were receiving the widow benefit prior to receiving disability benefits from Prudential, which is another reason that they should not be entitled to the $7,000 they are seeking.

Michael:

I live in Texas. I was awarded SS disability in July 2009 and it was backdated to April 2008 (12 months before I filed.) The date of onset was determined to be in July 2007.

My LTD carrier deducted the award amount ($20,000) from my monthly benefit check until it was paid back to the LTD carrier.

Today (8-15-2011) the SS office finished a review of my case and decided to reset the date of onset to early 2009 and says I have $19,000 overpayment. I will work a payment plan out with them.

My question is can I recover the award monies paid to the LTD? It seems fair because I no longer have the award technically.

I hope I worded the question correctly.

Attorney Greg Dell:

Michael,

You may be able to recover the money you paid to the disability carrier. You need to be careful that you don’t jeopardize your current claim with your disability company. You will have to send a letter requesting money back from MetLife if you choose to go that route.

Confused:

I was approved for social security, March 2011. They paid me 5 months backpay. I didn’t tell my longterm disability that I was approved for SSD because I know I have to give them back all that reward money. I am handicapped and disabled and this money will help me a lot for my medical expenses. I did not sign the papers that the long term disability sent me so that they can get information regarding how much benefit I get from SSD. Will my longterm disability find out that I’ve been collecting SSD. I am confused and don’t know what to do. If I tell them the truth now, they might question me why I did not tell them that I’ve been collecting SSD benefit and I will end up in jail. I need help.

Attorney Greg Dell:

Confused,

You have a contractual duty to tell the disability carrier about your SSDI. You do not need to be concerned about being arrested as long you don’t commit insurance fraud. You cannot lie if they ask you if you are receiving SSDI.

Murielle:

I am on soc. sec. disability and Metlife is also the ltd. insurance carrier since 2001.

Prior to Metlife, Northwestern was the ltd. insurance carrier and they did not deduct the social security cost of living every year from their benefits. They were the ltd. insurance from 1987 to 2001.

Now Metlife is reviewing my case and claim they have overpaid me since they apparently never send in to Soc. Sec. with the release I signed to them right from the beginning.

Do I owe them anything since for 14 years the other ltd company never adjusted my monthly benefits for cola.?

Attorney Greg Dell:

Murielle,

If the policy states that SSDI is an offset, then MetLife may be entitled to an overpayment reimbursement. However, I am not sure that they can go back and recover 14 years. Also, there are some cases that limit an insurance companies ability to recover for an overpayment from funds that have already been paid. You can find some of these case on our website. Your Northwestern Life disability policy will govern your claim if you were disabled when the Northwestern policy was in force.

Rick Jamison:

I was on LTD through Metlife. I filed for SSI at my company’s insistence and signed an agreement that if I was awarded SSI I would pay Metlife back through their attorney representing me and a portion would go to the attorney. I was awarded the back payment, I sent the major part ($33,000) to their attorney as instructed, the attorney in turn paid Metllife. I also paid the attorney representing Metlife (me) seperately. Both checks were cased and paid out (cancelled checks). Subsequently, several weeks later my checking account reflected a credit in the exact amount of $33,000. It took a few months for them to contact me but they when they did they wanted me to “pay them back” and that it was a an error on their part. What if anything can they do to make me “pay them back”

JR:

Mr. Gregory Dell,

I understand that Insurance companies have lobbiest at D.C. and are the reason they have group policies that setoff overpayments of SSDI income but it should actually be treated like any other federal income (VA, Retirement etc.). But – like most messages on this blog – why should they benefit from government funds that most Americans earned for contributing to social security? If we paid premiums to STD/LTD insurance companies what is the benefit of claiming against them since eventually they are going to get back the offset or overpayment of income received from SSA which we actually contributed to? Why has Congress not looked at this and realize that these insurance companies are actually stealing from citizens of this country and only one that benefits is the insurance companies?

Attorney Greg Dell:

Rick,

Metlife can either stop paying your benefits or they can sue you to attempt to recover the $33,000. Whether or not a lawsuit would be successful depends on numerous factors sucha s the language in your MetLife disability policy and the law that will apply to your claim.

Kelley:

I was on LTD back in 1999-2003, at which time they discontinued my coverage. I received my SSDI around the same time so I wasn’t too concerned about continuing my coverage with them, they were always trying to cancel my for one thing or another and my doctors were getting tired of filling out their paperwork every month. Well, June 2011 I am contacted by a collection agency and am told that I owe a large amount of money to my LTD company. I was never informed via mail, phone or person of this debt until 8 years later, I moved out of state around that time. I am still disabled and there is no way for me to pay this back. I am scared to death and having a lot trouble sleeping, my doctor has had to add anti anxiety meds. My question is can they still come after me after 8 years. I have looked up statutes of limitations in both states (the one I lived in while receiving benefits and the one I live in now) but I am unclear what kind of debt this falls under. I responded to the letter from the collection agency, they sent me a letter that does in no way prove I owe the amount they say I do. Please advise.

PG:

I recieved LTD in 2008-2009, maybe about 12 months – not sure, but I haver suffered many years of no income at all. I’m still disabled but out of fear of losing my chance at getting any money at all I went with the judgement under the premise that I can go back within six months to refile for SSDI since I agreed to a closed disability time frame. So I was awarded around $30K and now I fear that MetLife is going to state that I have to pay them back everything. What happens if I don’t pay them back? I have been working on getting my debt cleared and pay back some school loans and think that I’m going to file backruptcy. I’m not sure what to do or who I can go to for help.

Laura:

My husband had a loss of license insurance policy, had an injury and lost his license. After having paid premiums for seven years, the loss of license insurance co. refused to pay benefits to cover our expenses until he signed a paper stating he would file for Social Security Disability. He did get the disability after two years and now the loss of license insurance wants his back payments. Can Social Security or Veterans benefits be guaransheed if he is sued and loses? I have read these benefits can only be taken by student loans and government issues. What can happen to him if he refuses to give the back payments to this company? Could he be arrested?

Attorney Greg Dell:

Laura,

The issue with the overpayment is a civil matter which could not result in an arrest. He can be sued and he could be responsible for attorney fees in addition to the back SSDI benefits. This all makes the assumption that his disability gives them the write to seek an overpayment.

Attorney Greg Dell:

Kelley,

I don’t know what state you are in, but it does seem that the statute of limitation has run and they should be prohibited from collecting anything from you. You should demand that they prove what you owe them for. I doubt they will sue you to make a recovery. You should contact a collection attorney to see if they are violating any of your rights by seeking collection 8 years later.

Attorney Greg Dell:

PG,

If you were awarded SSDI for a period of time that cover the same time period you received MetLife coverage, then MetLife may seek an overpayment. If you are no longer dealing with MetLife, then it is unlikely they will ever know that you received the 30k from SSDI. If MetLife seeks a repayment, they may have the right to sue you in order to seek repayment.

Hard Worker:

I got very sick and began receiving short term disability in 2009. I then was approved for long term diability in 2010. In 2011, when I was 70, I applied for and began receiving my social security retirement income, which was retroactive 6 months. I needed this money to assist me due to the reduction in income. I notified the disability insurance company, who now says I owe them several thousands of dollars because social security retirement is a deductible source of income. How can one’s social security retirement income be an offset when it is my money, no one contributed to it but me, and it is based on the income I earned over the years? If I had not gotten sick and was still working, I would still be entitled to it while collecting a paycheck; the employer would not offset. I waited until I was 70 to collect because of the enhanced benefit option the the SSA offers if you wait. Please help me understand.

Attorney Greg Dell:

Hard Worker,

The language of your disability insurance policy defines what types of income are setoffs. In most group disability insurance policies, any type of social security income is considered an offset. If your policy does not have such language, then the disability company is wrong to deduct your social security disability retirement benefits.

Stupid:

I have a group STD and LTD plan with Unum. I was awarded STD, they started paying and stoped 4 weeks short. I was then approved on the LTD (STD never finished paying). 45 days into LTD they stoped paying. I have been turned down twice for SSD and I am currently waiting on the appeal. I am also waiting on a court date for a case against Unum (both STD and LTD). They have called after 18 months, now wanting to know if I will settle the case out of court. I was thinking I might. Listening to numbers, I hear that if I go to court the judge will only reinstate (and figure back payments) on the off set amount (a shortened payment by my entitled SSDI), which i have not been approved for. Is this right? Or is this a trick to get me to settle for less? The amounts STD and LTD were paying were not offset amounts. How can this change just because they want to? I understand paying back the lump sum if and when it happens but before? Would a judge do this? And I am told if SSD does go broke in 5 years the LTD will still only have to pay the offset amount (never having to make up what SSD can’t pay). Am I being lied to by more than Unum here?

Marie:

Gregory,

I am also dealing with Lincoln Financial like Kristina above. They are demanding I pay back money to them that I never received. My social security did not activate until my child was an adult. Lincoln claimed I was eligable for dependent pay, so I conctacted the Social Security department. They told me I was not eligable because she was 18, but that she could get the money. So she went in and applied and was paid back pay for the time of my disablility until she turned 18. Not a penny came to me and she doesn’t even live with me. Lincoln has played the delay game now as the “review” my “very unique” circumstance and after almost two months told me that the language of the policy states I must repay this money that I never received nor have any access to! They encouraged me to “appeal” it, a common delay, deny, hope they die tactic. They claim there is Michigan case law for this, so before I start incurring further attorney fees, is this true? Is there some law that says you have to pay back money that was never paid to you?

Thanks.

Attorney Greg Dell:

Stupid,

If you have not been awarded SSDI, then it would be unusual for a judge to enforce an offset. Some policies allow the disability carrier to estimate the SSDI award and offset in advance. If you are in litigation already then a settlement usually involves a buyout of your policy. Please call us if you would like to discuss your claim.

Attorney Greg Dell:

Marie,

The answer to your question depends on the setoff language in your policy. If your policy states any SSDI benefits you or your dependents receive, then Lincoln Financial may be correct. It is unfair. If your daughter is not claimed as your dependent then the carrier may not be entitled to the offset. You should submit an appeal in a timely manner in order to preserve your legal rights to sue them.

Faye with bad heart:

I became ill in late November 2008, and went on LTD in May of 2009. Unum, my LTD carrier, ended my coverage this May 2011. I am appealing their decisions, but want to know if I am awarded SSDI will I need to repay Unum because they terminated my LTD?

Attorney Greg Dell:

Faye,

If you received SSDI benefits for the same time period that UNUM paid you, then you would technically be required to pay UNUM back a portion of your SSDI award.

Rochell:

I have been on long term with MetLife since Oct. ’07. More – I am expecting a lump sum payment from workers’ compensation. Do I have to pay it all to MetLife at one time or make payment arrangements?

Attorney Greg Dell:

Rochell,

MetLife has the option to allow you to enter into a payment plan. You need to ask MetLife.

Emily:

I was awarded a back-pay and Hartford has waited four months and sent a letter wanting back pay. I want to know how these insurance companies can keep getting away with this? They can garnish my disability check? If so, why did I pay out of my check every month? Should it not be unlawful for them to do this? I need help, I can’t afford to pay them back. I have already paid bills, can I not fight this?

Attorney Greg Dell:

Emily,

Your disability policy should contain specific language explaining what Hartford can or cannot consider as a set-off. Unfortunately, almost all group disability insurance policies contain language which allows them to offset your disability check with payments your receive from social security disability or other potential sources. You may want to ask Hartford for a payment plan if they are entitled to the money.

D. Flanagan:

I am like all the rest – paid my social security for my whole life and bought short term and long-term disability insurance. I became ill from the trigger of the stupid “canned” air everyone in offices love and despite my request that the person across the way and to his supervisor that it not be used. I now have 33-40% reduction in lung function and am permanently disabled. Guardian Disability is a company from whom group disability coverage is provided. They are wanting the entire social security payment $18,000. However, I was never provided with a copy of the contract until recently. The full terms and conditions of the policy were not provided to me. Additionally they will received the benefit of my years of having paid to SSA to the tune of their reduction in their obligation by over 55%. Since the premium was based on income – shouldn’t I have benefit of the reduced premium and return to me of the 55%? Is there a cap over which they cannot take it all? With the government struggling – does the public know this?

Attorney Greg Dell:

D. Flanagan,

The government is aware and they have taken no action. There is no refund of premium available in your situation.

Lennie Nicholson:

I understand overpayment, deductible source of income etc., but my question is this: can the LTD company basically force us to apply for SSA benefits? We are philosophically opposed to having the government pay for something that private insurance is contracted to cover. Its MetLife and the representative ALLSUP. The constant contact and pressure to get off MetLife and over to SSA disability benefits is driving me crazy but I don’t want to lose the LTD coverage either.

Attorney Greg Dell:

Lennie,

MetLife cannot force you to apply, but they can deduct an estimated amount each month that you would receive from SSDI. I have seen them do this many times.

Broke:

What happens if you do not report lump payments to Ltd. Co.? Will they find out?

Attorney Greg Dell:

Broke,

If you are asked about information and lie to an insurance company then you could be subject to insurance fraud criminal charges.

Malis:

A friend of mine is on Social Security Disability and she is thinking of filling a lawsuit for personal injury due to an accident. Would her SSD income be effected if she gets a settlement, and does she has to report that settlement by law? Thanks.

Darlene Mason:

I am receiving LTD from Unum, this month is the fourth month for LTD. Unum sent me a letter stating I am getting retirement money, so I owe them 1,700 dollars. Unum has suggested I sign up for SSDI; so I signed the option A or B form, stating that I will pay Unum any overpayment that I get from SSDI. In the letter they sent me they included the form about giving them any overpayment after I get SSDI. I did not get any overpayment from my retirement fund, so can I repay when I get my SSDI award?

Attorney Greg Dell:

Darlene,

You can negotiate a payment plan with UNUM to discuss repayment of any money owed. You should look at your policy closely as UNUM may not be entitled to an overpayment for your retirement money.

Dennis:

I am receiving LTD from Prudential. They require that I apply for SSDI and want to apply any retroactive award as an offset to benefits they pay me. Question is, that if I have an attorney assist, I will owe them about 25% from the award as fees. Will Prudential want 100% of the retroactive award, or will it be 100% less the attorney fees?

Many thanks.

Attorney Greg Dell:

Dennis,

Prudential will give you a credit for the social security disability attorney fees that you will need to pay. Your SSDI attorney fees will not exceed $6,000. So if you are awarded $20,000 from SSDI and then the attorney fee is $6,000, Prudential would only be entitled to $14,000.

B. Johnson:

My husband just started receiving SSDI; therefore I have applied for SSDI for myself and our daughter. He also gets LTD benefits so LTD will be taking back part of what they paid and they will decrease what they pay accordingly. I signed my daughter’s SSDI application obligating myself to do as the federal government outlined (if I don’t, it’s felony). One of the bullet points said that I MUST use child’s benefits for needs of the child or put it away for the child. If they find out it’s not used appropriately they will immediately stop paying.

Doesn’t this statement from SSDI prevent LTD from taking her benefit away?

Nate:

My long term disability insurance company called and said I get all my social security settlement money and I do not owe them back pay. He said he calculated it and they were 100% sure I’ll get it. I asked multiple times if he was right and he said yes, then a day later he calls and says I owe him the back pay. Is that money mine through a verbal contract?

Attorney Greg Dell:

B,

If SSDI is paying child dependent benefits as a result of YOUR disability and not your husband’s, then the disability carrier should not be entitled to an offset for the child benefits that you receive.

Attorney Greg Dell:

Nate,

In the world of disability insurance claims, there is no such thing as a verbal contract. You should speak to a supervisor at your disability carrier and get everything in writing.

Margaret:

Can my client sue for a bad faith claim against her LTD carrier?

The carrier claims they are owed over $60,000 in payments and have estimated her SSDI award even though I have sent communication requesting an appeal of the overpayment decision and am awaiting the award letter from SSA stating her award was $18,000. Further, my client selected to receive her LTD benefits with no reduction at a time when she was on pain medication and practically forced to select that option by the LTD representative.

Is there any merit to a coercion defense/claim when filing the appeal?

Attorney Greg Dell:

Margaret,

If this is an ERISA governed disability claim then there is no right to bring a bad faith claim. You should file a claim with the department of insurance in the state where the claimant resides.

Dar:

I am getting LTD. They made me apply for SSDI. While waiting for approval, can I apply for social security retirement? I am 62 years old. I understand there may be a long wait for SSDI. If I get the SS retirement, I know when SSDI comes through, I will get the SSDI only. What I would like to know is, if I get SS retirement, will LTD still pay me also, until I get SSDI? I am worried that I cannot get the amount from the LTD carrier, also.

Smalin:

Hello!

I’ve been collecting LTD through SSDI and MetLife for 14 years. My husband recently became disabled as well and now our daughter collects on his work record. I do not believe that dollar amount should now count as a MetLife deductible for me, since it is considered from him.

I have also gotten an increase in my SSDI due to his record. Would this money be counted as deductible income by MetLife? I am well over the 70% guaranteed income with this added income.

Not sure if I should contact them or let it be.

JP:

I was injured at home in Jan. 2011 and went onto STD, then LTD with the Hartford in April. I tried to return to work by aid of wheelchair and walker but was told, several times, I could not return to work until I could walk without assistance. I was allowed to work from home up to 18 hours a week, until I was terminated in Aug. 2011, due to longevity of injury. The part-time income did not affect the LTD.

Today I got a call from the Hartford asking if I had applied for SSDI (yes), said she was sending a form for me to sign, stating I would pay them back all I had received since July 2011 once I get the SSDI. I do not have a copy of the LTD insurance policy, since employer kept the handbook that had all this info in it.

Do I need to sign this paper and return, do I have to pay them back $2400 a month, retroactive to July 2011, once I am awarded SSDI? I have filed with the EEOC, handicap discrimination, but have not heard back about a hearing date yet. I am so lost here. Please give me some general advice about Georgia law on this.

Attorney Greg Dell:

Dar,

You will likely get more money if you are approved for SSDI rather than SSI. Either way, the disability company will offset your monthly check. You should try to get the SSDI first.

Attorney Greg Dell:

Smalin,

If your daughter is no longer collecting from SSDI as a result of your SSDI, then MetLife may not be entitled to the offset for her any longer. They will offset the SSDI from his policy if your daughter is receiving payment as a result of his SSDI approval.

Attorney Greg Dell:

JP,

You need to send a request to your employer requesting a copy of your LTD plan documents. If the policy states that Hartford has a right to reimbursement for SSDI, then you will need to pay back any SSDI funds you receive for the period that coincides with LTD payments. If you don’t sign the paper, Hartford may start to offset your monthly benefit check.

JP:

My question is: I was billed bi-monthly by employer and had to pay for my LTD & other insurance after-tax (out of pocket) after the accident in order to keep my insurance in effect. Does that make it exempt from Hartford being able to claim overpayment if I get approved for SSDI?

We have the right to recover from You any amount that We determine to be an overpayment. You have the obligation to refund to Us any such amount. Our rights and Your obligations in this regard may also be set forth in the reimbursement agreement You will be required to sign when You become eligible for benefits under The Policy.

If benefits are overpaid on any claim, You must reimburse Us within 30 days.

a) the United States Social Security Act or alternative plan offered by a state or municipal government;
(Other Income Benefits will not include the portion, if any, of such retirement benefit that was funded by Your after-tax contributions.); or

5) retirement benefits under:
a) the United States Social Security Act or alternative plan offered by a state or municipal government;

Attorney Greg Dell:

JP,

Unfortunately, you will not be exempt from an overpayment.

Betty Smith Lee:

Hello,

I’ve been receiving Social Security Disability and LTD from my company and Aetna deducts the amount I receive from SSD from my LTD check. Now, I got a letter from SSD saying that I will get 3.6% increase in pay. Can Aetna deduct the increase (COLA) that I will get from SSD from their checks? If so, it means that I will have to live with whatever the amount they set up for me for years until the SSD catches up with their payment and then Aetna doesn’t need to pay me anything? Please let me know, it seems unfair that when I get a COLA, Aetna deducts the amount from their checks, which will end up with nothing to pay to me. Thanks.

Attorney Greg Dell:

Betty,

The answer depends on what your Aetna disability policy says. Some policies do not offset for COLA increase from SSDI. Check the language of your policy. If the policy includes COLA increases, then your analysis is correct.

perko:

I received LTD from Prudential and I filed for my social security retirement in Texas and was awarded it at the amount of 2034 dollars. So when I filed for SSDI from the state, I was awarded it and it made my check go up 500 dollars. Prudential cut my LTD check off because it says my social security check is an offset. What I am saying is, why do they include my retirement instead of the 500 dollars disability extra a month that I was awarded?

Attorney Greg Dell:

Perko,

Some Prudential policies have language that includes any retirement benefits as an offset. You need to check your policy.

Tony:

I have the same problem as most: paying back the LTD insurance, MetLife. Can they actually garnish my only income, SSDI, if, for any reason, I did not, or could not, repay them?

mary:

OMG, I am so confused! My husband works for AT&T and was on STD for one year after a car accident and is now been approved for LTD and AT&T has a company that is filing for SSD for my husband. His accident was in Jan. 2010 so he is eligible for SSD since July 2010.

If approved, does he get backpay or is that gonna have to be paid to someone for offsetting his STD and LTD?

Attorney Greg Dell:

Tony,

As you can see from the extensive comments above, the answer is unfortunately yes.

Attorney Greg Dell:

Mary,

If approved for SSDI he may need to give money to AT&T. You need to read his policy.

Clay:

I had to leave Verizon Wireless do to seizures & anxiety. VZW used MetLife for the company’s LTD insurance. MetLife approved LTD for 2 years from 11/09/09 to 11/09/11. MetLife ended my LTD benefits early on 2/1/11 claiming that I had no issues and could return to work. A specific example, they claimed that I could drive to which all my medical doctors had said no, due to the seizures. An issue that fell under the scope of the policy and was used in my SSDI hearing.

MetLife had a requirement that I file for SSDI and I did using their approved law firm Allsup. I was just awarded SSDI benefits and MetLife is now claiming they should be reimbursed for 11/09/09 to 2/01/11 benefits. Is this correct, since I believe MetLife refused benefits to me, the policyholder with a legitimate claim, and acted in bad faith?

Attorney Greg Dell:

Clay,

Technically MetLife is entitled to claim an overpayment for the same months that they agreed you were disabled. Since they have stopped paying you, I am not sure they will take any action to come after you for the overpayment money. I am assuming you appealed your disability denial? You may be entitled to additional long term disability benefits, which could offset any amount you owe to MetLife.

Chante':

I have been receiving LTD benefits from MetLife since Feb. of 2009. I was just recently approved for SSDI benefits. I was previously told I would have an overpayment amount to pay to them when/if I was ever approved for SSDI after appealing up to the ALJ level, which I was told is a “requirement” after 24 months of LTD. However when SSDI gave me my benefits amounts, I was told I would tentatively receive a gross amount of $1,450 monthly. And after Medicare reduction of $115, I would now net $1,335 monthly. But from MetLife I have received an amount of $1,317.42. In this case where both my net and gross exceed the amount I’ve been getting from LTD, would I actually owe MetLife back pay? As well, I obtained Binder&Binder for my ALJ appeal. Their fee is 6K, will that also be taken into consideration? Finally, MetLife has not been my employer’s insurance/disability since Jan. of 2009, but because I was out the entire year of 2008 and returned for only 5 days in 2009, I fell under the MetLife umbrella before the insurance transition was complete. Would that be another reason to {not} have to pay into back payment? Any help would be greatly appreciated, as Everyone within MetLife talks in circles.

Frustrated:

First I like to say that UNUM is the worse insurance company, EVER! They treat you horribly. I don’t know how their employees sleep at night. I have been receiving LTD since Aug. 2010 and was approved for social security disability Oct. 2011. UNUM lowered my payments from $1,200 to $134 and recently informed me I will no longer receive any money from them. I informed UNUM that I was approved and they immediately asked for repayment. I recently paid medical bills and payments towards my living expenses in order to bring myself up to date. UNUM has been calling me demanding I pay $17,800 which I only have $5,000 left from my retro from social security disability. My question is, can they send me to collections if I send a lump sum of $5,000 and then make monthly payments of $100?

Attorney Greg Dell:

Chante’,

The $6,000 SSDI attorney fee you paid will be deducted from any amount you owed to MetLife. It seems that your SSDI amount will wipe out any payment from MetLife. MetLife will seek an overpayment for any funds that were paid to you by SSDI. You are required to pay MetLife back if your policy contains offset language.

Attorney Greg Dell:

Frustrated,

If you contact UNUM and attempt to work out a payment plan, you can probably do better than the proposal you suggested. Good Luck!

Donald:

I have long term care with MetLife and have never filed a claim, but I have total kidney failure and am getting SSDI $1579.00 a month and VA 100% $2800.00 and not working – sick everyday. Should I continue with MetLife or stop it and should I request a claim for kidney failure? I know they will offset the SSDI, but what about VA, I need additional income because of this disease?

Attorney Greg Dell:

Donald,

We cannot answer your question without reviewing your policy.

Pam:

I have been on disability for 18 years with RA. I receive SSD and LTD through my former employer. My employer has had various insurers through the years. Our new insurer, Prudential, sent a letter requesting beneficiaries sign authorization form for all medical records, labs, hospitals, X-Rays, health care professionals, pharmacy, health plan and health care provider who have provided treatment, payment or services to me or on my behalf to disclose my entire medical history concerning me. They want to know if I smoke, drink or take drugs. They want it all but psychotherapy notes. OK, I can do that. No problem. Prudential also wants authorization to contact the social security administration or other persons or institutions to provide any info, data or records regarding social security administration, credit, financial, earnings, activities. If I don’t sign this authorization Prudential may not be able to process any payments to me. My policy states I must release medical records. There is no mention in my policy to release any thing else! I don’t think I should sign a form for my insurer to look at my credit report, bank statement and whatever other financial records they say they “need” for me to receive benefits. What do you think about the financial stuff?

Attorney Greg Dell:

Pam,

Great question. When I have my clients complete these General Authorizations, I usually have them cross out request for records relating to credit, financial, tax returns, etc. I tell the disability carrier that if there is a specific non-medical record they are looking for, then they should specifically ask us for it in writing.

D.P.:

My LTD carrier has an offset clause for dependent benefits and I’m OK with that. If my SSDI claim is approved they will reduce my benefits by the SSDI amount received for me and my children. My son’s Dr. recently advised me to apply for SSI for him as his migraines are severe enough to keep him out of school, activities, etc. So my question is, if he is approved for SSI for his own condition and his benefit amount is more than the dependent benefit, can my LTD carrier offset this amount? Or, since his will be an individual application aside from my own will it be exempt from the offset? Thank you.

Attorney Greg Dell:

D.P.,

If your son received SSDI benefits due to his own disability, and not yours, then the disability carrier could not take an offset.

Barbara Braman:

My LTD made a point to state they approved my claim for my back problems and not my depression. SSDI was approved mainly due to my depression. Is my LTD company still entitled to the SSDI back pay?

Also, I have a pending lawsuit against a driver in an auto accident who hit me while I was recovering from back and neck surgery and made it bad again. This will mostly be pain and suffering and not lost income as I had already been laid off from work for taking medical leave. Is the LTD company entitled to anything I might get from this lawsuit?

Bill:

I have been on long term disability for a year through my employer. I tried for a year to get back to work but failed. I was just approved for disability retirement (Dr. states totally and permanently disabled ) through the benefits office. They back dated my retirement date to one year ago when I started long term disability income. I have a 401-A. Can the long term disability company pull the plug on my income AND claim? I owe them all of last year’s income back because my retirement date was backdated to the point my long term disability benefits started. I’m 51 and in terror since I don’t have much in my 401. Their lawyers are trying, but have not yet gotten me approved for SSI so they can get that backpay but I’m thinking this may be lose-lose for me. Your thoughts?

Lost:

Why do you have to pay your Ltd. insurance company back any money when you paid for the service or benefits out of your paychecks while working? This is money you deserved. Why should they be allowed to get any money that you get from SSDI? Why should the disabled person be out any money?

Attorney Greg Dell:

Bill,

If you get paid SSDI during the a period of time that is the same when you were paid Disability Insurance Benefits then the disability company may seek an overpayment. They can only seek an SSDI overpayment if your disability policy gives them the right to do so.

Attorney Greg Dell:

Lost,

You are only required to pay back disability funds if your disability insurance policy gives the disability carrier the right to request a repayment. The right to a repayment of disability benefits must be contained in the language of your disability policy.

Bill:

Dear Lost,

I believe my employer paid the premiums. I have to pay taxes on it and these other concerns are paramount. I know they can get my SSDI check and then offset that future payment. I can live with that because my income would not change. I can’t survive a hit to my puny 401 A.

Attorney Greg Dell:

Barbara,

You need to check the language in your policy. The SSDI funds will likely need to be paid back to the company. The proceeds of an auto accident related to lost wages only may be an offset.

Susan:

I received 5 months initial settlement on SSDI – I promptly contacted the insurer and told them. They advised me of the amount I would need to reimburse them. I sent the check and it was returned to me 6 weeks later asking me for the Claim Number. I was finally contacted about 3 months later asking where the money was – I told them it was returned to me. I then wrote the claim number on the check and their letter and sent it back to them. They sent the check and their letter back to me with no explanation. Now about 6 months since this started they are calling me for the money again and threatening to stop sending my monthly benefit. Am I required to send the money to them, since I have already sent them the money twice and they don’t cash the check?

Attorney Greg Dell:

Susan,

That is a bizarre story. Which company was dumb enough to do this to you? If your policy entitles them to an SSDI overpayment, then you need to send the money.

John:

OK, from the posts these insurance companies are a royal pain. In our case it is the Hartford, total jerks. We ended up sending them the overpayment after being approved for social security disability. After about 10 months we received a rather large amount because we were not paid the correct amount. Now they are saying the amount our minor daughters receive can be used for offset. Is this correct?

Kelly Gordon:

My long term disability just ended. I was wondering if long term disability pays into unemployment since I have to pay social security, medicare and taxes on my disability benefits.

Concerned:

My long term disability company required that I apply for SSDI and give them any settlement I received. I understand this and complied. However now they are trying to get benefits that my daughter would have received for the time I was on disability and she was a minor. She is now over 18 and is set to receive $5K. Can they legally require that she return that money?

Please help:

My wife was just approved for SSDI and has received her lump retroactive payment. Her long term disability company says that that money belongs to them but we have been told that we have to pay taxes on that money. Is this true? Shouldn’t we pay the taxes out of the money and then give them the remainder? No one seems to be able to answer this question for us. Thank you.

Attorney Greg Dell:

John,

Please see the following Frequently Asked Question regarding the SSDI issue for minors at Can a disability insurance company claim an overpayment for social security disability benefits payable to a child as result of the parent’s disability?.

Attorney Greg Dell:

Kelly,

There is no relationship between unemployment and long term disability benefits. Most people receiving unemployment are not eligible for disability insurance benefits.

Bill Hopper:

Can 401 money be an offset if you are disabled and “eligible” to receive your 401 money?

Chris:

Say you get $2150.00 for LTD and Social Security Disability awards you $1700. Don’t you still get the 60% from your LTD insurance company? My wife has been disabled from 2001 and she gets 60% of her salary from LTD and $900 from Social Security Disability.

Attorney Greg Dell:

Chris,

The SSDI payment will be subtracted from the LTD monthly benefit amount.

Attorney Greg Dell:

Bill,

It can be if your policy specifically addresses 401k benefits. You should ask your carrier for clarification in writing.

Concerned:

I do understand that the majority of LTD insurance companies have policies in place that require any amount given as an overpayment for social security disability benefits payable to a child as result of the parent’s disability be given back to the insurance company. My question asks that if my daughter who is no longer a minor and I have no financial control over be required to give back the money that was deposited into her bank account. What if she refused? How could I be held legally responsible for this?

Attorney Greg Dell:

Concerned,

Please see our FAQ on this exact issue at: Can a disability insurance company claim an overpayment for social security disability benefits payable to a child as result of the parent’s disability?

Attorney Greg Dell:

Please Help,

I get this question all the time and I agree with your thought process. You should send a letter to the disability company and tell them your situation. I think the argument you are making only makes sense if the disability insurance benefits your wife was receiving were tax free.

Attorney Greg Dell:

Concerned,

The disability carrier will not require your daughter to give back the money. They will hold you as the parent responsible for paying any overpayment regardless of the bank account in which the SSDI money was deposited. Your daughter received the money because of your disability, therefore your policy may make you responsible for the overpayment.

Geeman:

I am receiving monthly LTD from Unum, recently received SSDI approval. The retroactive amount I received from SSDI is fully taxable to me. Can I withhold an estimated amount for taxes on the “overpayment” and remit only the net amount to UNUM? The LTD monthly amount I received from Unum was roughly 33% taxable.

Attorney Greg Dell:

Geeman,

Unum will tell you “no” and I am not aware of any case law that allows you to do this. I think you should be able to and I have argued it before to insurance companies. I am not aware of any legal rulings on this issue.

B.J. Moorman:

I need your help! I received a Long Term disability monthly payment and then the LTD company helped me get approved for SSDI and the LTD company took the back payment award that I received (which I knew that they were going to do). My question is this: I was supposed to pay taxes on the LTD but never did because we had to pay them back the SSDI. Am I liable for the taxes on the LTD still?

Attorney Greg Dell:

BJ,

Unfortunately your question needs to be answered by an accountant and is beyond the scope of our expertise as attorneys.

Gail:

I see similar questions posted but they don’t completely answer my question. I have been on Long Term Disability and was finally awarded Social Security Disability after two and a half years. I know I have to return all retroactive money to my employer’s long term disability company. My question is, do I return all of the money and have to deal with the tax implications at the end of the year? That really makes no sense to me because I was already taxed each month when I received a long term disability check. Isn’t that double dipping?

Attorney Greg Dell:

Gail,

I agree with your position that you are potentially being taxed twice. We cannot specifically answer your question regarding the tax implications because an Accountant is best suited for this. It is unlikely that you will be double taxed. You can also call the IRS customer service line and receive an opinion directly from them.

Sheila (between a rock and a very hard place):

A couple of the replies that I have seen regarding the SSI or SSDI backpayment (or overpayment as described by LTD insurance companies) may need clarification. One reply stated that the LTD carrier will seek the entire amount of the SSI/SSDI back-payment, but what it doesn’t say is that they can only legally receive the amount of the backpayment where the benefits overlap. I.E. SSDI started paying benefits effective May 20, 2009 through May 20, 2011. SSDI is approved and back-payment check is cut to cover from January 1, 2009 to May 20, 2011. The benefits paid by SSDI for January 1, 2009 through May 19, 2009 are NOT owed to LTD insurance company. And the insurance company owes all claimants written notification and explanation BEFORE anyone should turn over any funds. A phone call doesn’t cut it as you need a written document that clearly identifies their decision and how they came to that decision by which to adequately reply. It is all a god awful mess.

Attorney Greg Dell:

Sheila,

You are correct that the disability carrier should only be entitled to an overpayment when there is an overlap of dates between when LTD paid and SSDI paid. We have seen carriers try to argue that they are entitled to an offset for the entire amount paid by SSDI. A claimant has a right to demand a written explanation and a mathematical calculation of how the SSDI overpayment was calculated.

Ken:

I have a question about offsets as well. I do not have short term disability and was planning to take distribution of my 401k funds to live off during the 120 days or greater it takes for the LTD company to arrive at a decision. Considering my funds would be pretty much depleted, can they still claim this offset to reduce my payments, it would seem extremely unfair to me, considering I am having to live off of these funds while I wait the 90 days for eligibility and who knows how long for a decision. I appreciate your thoughtful input in advance – Thank you!

Attorney Greg Dell:

Ken,

I have not seen your policy, but in most claims the carrier is only entitled to an offset for the 401k funds that are received during the same exact time period that LTD benefits are paid. If you stop receiving 401k benefits before the LTD payments start, then the carrier should not be entitled to an offset.

Sam Weissbach:

Here’s my situation: I receive LTD from STD Life of $3997 / mo. (non taxable, as I paid the premiums). I receive $1133 from Gov. disability (taxable).

They are deducting the gross amount from my net which was non taxable. So I receive $2864 (net) and $1133 gross (taxed at 38%). After I pay my taxes that means I actually receive a total of $3566 net. I have lost $433 per month (net). The $3997 was the max allowable under my policy.

Do I have a legit right to the maximum original amount of $3997?

Thanks,
Sam

Attorney Greg Dell:

Sam,

Unfortunately, I don’t think you have a “legit right” to the maximum original benefit amount of $3,997. The reason is that in calculating your monthly benefit the carrier used your Gross pre-disability earnings. If the carrier had used your after tax earnings to calculate your monthly disability benefit, then you would have a lower monthly disability benefit, but a better argument about the SSDI setoff. I think you situation is unfair and I see it everyday. We have yet to see a court case that allows this situation to work out the way you want it to.

Michelle:

I am 66 and employed. I got sick and went on short term disability and it has now ended and LTD will be kicking in in another month. I am considered still employed for another 6 months at which time if my LTD is still needed, I will be terminated for being out of work for 1 year. Will my disability payments be reduced by the amount of my SS payments?

Attorney Greg Dell:

Michelle,

The answer to this question depends on the language in your policy. Not every policy has an SSDI setoff. Most group disability policies deduct for SS payments.

Ken:

Thank you for the answer to my last post, it was very helpful. I have one further question and hope you can help answer. In the event I receive SSDI I realize that I will have an LTD offset, however, what if my son receives a benefit? My son lives with his mother and she has the tax deduction rights for him (we are divorced). Can the LTD company claim his benefit as an offset against me considering that I will not be receiving these funds and have no benefit from his benefits?

Thank you once again.

Attorney Greg Dell:

Ken,

If your son is receiving benefits as a result of your disability, then it is likely that the carrier will seek an offset for his benefits as well. You may be able to argue that he is not a dependent of yours as reflected on your tax return.

Arjay:

Mr Dell,

My Mom is undergoing chemotherapy for the next 15 months and has gone on disability through Standard which she has always paid into. Following recovery, she plans to go back to work. Less than a month into collecting her disability, Standard is now trying to pass her on to SSDI which could potentially effect her disability income and insurance coverage. Is there any reason she has to apply to SSDI? Can she simply say no, I will not apply to SSDI? There doesn’t seem to be any advantage to going onto SSDI and actually could be less advantageous.

Thank you.

Attorney Greg Dell:

Arjay,

The Standard may require her to apply for SSDI and if she does not, then they may offset her benefit by an estimate each month.

Tom:

Was involved in a third party liability lawsuit. Had many surgeries and procedures. Meds were paid by a Group Heath. Also had a fully insured group LTD policy. Filed and received SSA permanent disability. The LTD carrier declared I was disabled from Any Occupation. Injury was in July of 2007. Filed for Disability in Nov. 2007 and finally approved in Feb. 2010. After out of court (Aug. 2011) settlement, the meds were paid back, the LTD carrier was also paid in full.

Once the LTD carrier was paid, my monthly LTD benefits were restored. After all liens were paid, I received @100,000. Since the injury, I noticed a paragraph in the SPD under Deductible Income, that any settlement, award, judgement etc. was deductible income. Since all liens were satisfied, do you think the LTD carrier can claim the settlement award? I live in Tennessee (6th circuit), we have the Made Whole Doctrine as a default rule.

The economic expert from my lawsuit determined my total losses at 1,900,000. Meds and LTD carrier got @50,000, attorneys got 100,000, I received 100,000. Seems to me I was not made whole. The LTD carrier has not denied me any benefits, but I know from your online articles and videos, denial of my benefits are probably coming. The LTD carrier participated in the settlement via Enginix, a subro co. The med liens were handled by Rawlings, a subro co. The LTD co. also received an overpayment settlement in full.

Since the LTD carrier signed off on the settlement, how can they subrogate going forward? Any money I received are for the future loss of income, pain and suffering, loss of enjoyment of life, permanently disfigured, permanent disability. Any thoughts?

The SPD does not abrogate the Made Whole doctrine, no mention of first dollar priority. What do you think?

Attorney Greg Dell:

Tom,

Since the LTD carrier seemed to release their lien at the time of your third party settlement, I don’t see why you would have an issue moving forward. You should speak with your original personal injury lawyer about your concerns.

Barb:

I have been on long term disability, through my employer group insurance, since 3/15/2011. I was advised to apply for SSDI immediately. I did that. I was advised by the insurance carrier that if I get denied, they appoint a company to handle it for me, at no charge to me. When I was denied the third time, that company was poised to go before a judge with me. That became unnecessary as I was approved before that happened.

Even though I have not received anything from Social Security dating back to after the 5 month waiting period, my disability insurance has presented me with an over payment due of close to $7000. They came up with the figure by deducting my SSDI from my gross disability income. Is this normal?

Attorney Greg Dell:

Barb,

It is normal for the insurance company to request an overpayment. You should not have to pay them until you receive the money from Social Security.

Brent:

I receive SSDI for a blindness disability. I am legally blind and went back to work part time for some extra money. I have been paying into a short and long term disability plan with my employer. My blindness has progressed and I can’t continue. I am making about $600.00 biweekly working, but will UMN offset that against my SSDI, which is more and pay me nothing? In the policy it shows Social Security payments as an offset. Should I even continue paying into short and long term disability ?

Attorney Greg Dell:

Brent,

Your situation is unique. I am assuming you are referring to a Unum disability policy. If you are receiving SSDI then you may loose your SSDI if you earn more than $900 a month. If you are working for a new employer and have STD and LTD coverage hen you may be able to file a new claim, subject to a pre-existing condition limitation. It is likely that Unum will offset for any SSDI payments that you are receiving.

Maryanne:

My husband was forced by his employer to go out on disability when he came to work with a cane. He was on STD for 6 months, then approved for LTD in November 2010. In February 2011 we received a letter from his employer notifying him that he had been terminated retroactive to when he became eligible for LTD. My husband is a veteran who has been receiving VA disability benefits since he came out of the service in 1992. We just received notice that they are increasing his VA benefit retroactive to May 2010, a week after he was told not to come back to work. I have read the list of offsets in his LTD policy, and it does not specifically list Veterans benefits. It only says “any compulsory benefit act or law”. Can his LTD carrier demand his VA award back to May of 2010?

Attorney Greg Dell:

Maryanne,

There is some good case law which states that a disability carrier cannot offset long term disability benefits as result of VA benefits that were being paid before disability insurance benefits. Please take a look at our Frequently Asked Question about Veteran Benefits at Can Veteran Disability Benefits be deducted from my monthly long term disability insurance check?

Karen Simon:

Question. Like all the others, I was receiving LTD for several months. I was finally awarded SSDI, and hence receiving both. Unum notifies me that I owe them $28,837 because they forgot to withhold some of the Unum $$$. So I ask around to my SSD lawyer and so forth. They are not as familiar with this as clearly as your web site. I found a lawyer to “negoiate” a settlement with Unum. As you seem to have knowledge of this kind of case, will Unum settle for a lump sum? And – can I expect this to happen again, other than when I am eligible to get my pension? Secondly, is not the IRS angry about all the ammended tax forms?

Attorney Greg Dell:

Karen,

Unum may be interested in a lump-sum buyout of your disability policy. Any offer will include a deduction for the SSDI overpayment. Contact us if you would like to approach Unum about a lump-sum buyout. I don’t think the IRS gets angry about amended tax forms as it is a common practice.

Attorney Greg Dell:

Monica,

You need to notify the carrier that you received the money. Once they ask for it back, then you need to repay it. You could request a payment plan.

Monica:

How long can I keep the money before I have to return it? I would like to make a little interest off it at least.

Rick:

Gregory,

My wife was approved for Long Term Disability with MetLife. She applied for Social Security benefits and received them. She has sent that info to MetLife. However, we have a daughter that is 13 years old and Social Security just approved that benefit as well. Is MetLife entitled to Offset the dependent benefit as well? Thank you so much.

Attorney Greg Dell:

Rick,

The answer is probably YES. You need to see if the offset language in your wife’s MetLife disability policy includes dependent children.

Craig:

If one is collecting LTD whether for a short period (6 months to 1 year) or very long term and they receive an inheritance or an investment matures while on LTD can they request you to pay back both short term and long term payments received?

So just to be clear that insurance fraud is not the intention here I will be more specific. If you inform the LTD company immediately that your financial status has changed can they be entitled to all payments received for both STD and LTD?

Attorney Greg Dell:

Craig,

Passive investment income and inheritance are usually not subject to an offset by the disability carrier. Your disability policy will clarify these issues. It is unlikely that you will have to repay any funds. It is good that you have notified the disability company.

Steve Norris:

I have been receiving LTD benefits from my company for a little over 15 months. Last June the LTD Ins. Co. won for me SSDI through a third party. I received a lump sum in June of 2011 which I immediately returned to the third party. All along, my LTD benefits were and still are not taxable. I received a SSA-1099 showing a lump sum payout that I am now required to report as taxable income according to the IRS formulas. It seems to me obvious that I should not owe any taxes on the income, regardless of the source since the total amount has not changed from the original LTD monthly payments which are not taxable income. The Social Security and the IRS do not have an answer how to address this problem, via their forms. My original LTD is offset by the SSDI payment, if I had never gone along with the third party application for SSDI, none of my disability income would be taxable. Any ideas how I should address this issue before April 15?

Attorney Greg Dell:

Steve,

We cannot give any tax advice, but please see the following Frequently Asked Question on our website: Do I have to pay tax on my SSDI overpayment if I already paid tax on the disability insurance benefits for the same period of time?

R.:

Rick, I became disabled in 2008 after working 13 years with the same company. They hired a firm to help with SSDI and paid short term benefits followed by a year of long term benefits and then they denied to continue paying benefits and the firm that they hired said that my company agreed to no longer pursue my disability case and will no longer be representing me so I hired a different lawyer and filled out the forms with the judge to dismiss the firm and replace it with the lawyer… Would you believe 2 years later I finally get my hearing and I guess the firm was CC’d on it cause they started harassing me and calling my phone but sorry they told me they no longer would represent me. Will I still be required to pay them anything from my back pay? Keep in mind this is from a carrier that used every shady practice in the book including paying me 25 percent of what I was supposed to get, canceling my medical benefits while I was in the hospital on my death bed. I had to fight for all this to be fixed while very ill.

Attorney Greg Dell:

R,

If you are receiving any LTD insurance benefits and receive SSDI payment for the same time period, then you may need to pay back any SSDI payments you receive which overlap. You will be entitled to an offset for any attorney fees that you need to pay.

Christine:

General question. My husband is receiving SSD, and through his employer he had insurance that pays him a long term disability benefit of $100 per month as well. Now the long term disability insurance company is asking for the $ amount that our children receive from his SSD claim as dependents, so they can use it to determine how much to lower his LTD benefit. I think that the LTD was paid for by his employer as a benefit solely for him. The SSD benefit that our children receive as his dependents, as I understand it, is their benefit to be used solely for them. Their father and I cannot use any of their benefit for ourselves. This makes me think that they shouldn’t be able to use the children’s benefit to affect the amount of LTD benefit he gets. I’ve called all over but nobody seems to know weather I am correct or not and I don’t want to furnish the children’s information to the LTD insurance company if they have no legal right to it.

Attorney Greg Dell:

Christine,

Your husband’s disability policy will state if the disability carrier is entitled to an offset for dependent benefits paid to your children as a result of your husband’s disability. Please read Can a disability insurance company claim an overpayment for social security disability benefits payable to a child as result of the parent’s disability? for additional information.

Charmaine Morgan:

Can my benefit from my insurer continue if I decide to reside in another country, if they give estimated time all the way to retirement?

Attorney Greg Dell:

Charmaine,

Some policies require you to reside in the United States. You need to read your policy to see if it has any limitations on residence.

Robin:

I received STD then LTD; they paid my state and federal taxes. I have now been approved for SSD and received the back pay and starting to receive monthly payment. My STD/LTD carrier (Unum) wants to be repaid the amount I received from SSD in a lump sum. This has caused a HUGE hardship being off work and receiving less pay.

I already paid taxes via Unum, however now that I have received the payment from SSD and have to repay Unum, will I have to pay taxes AGAIN? Doesn’t seem right to have to pay taxes in originally, then have to pay it back to Unum from the lump sum and pay taxes again.

Also, when it causes a financial hardship, do you have to repay the STD/LTD?

Confused.

Attorney Greg Dell:

Robin,

You can ask Unum for a payment plan to repay the SSDI. You may also be interested in a lump sum settlement of your claim which you can call us to discuss. With regard to the double taxation issue, please read Do I have to pay tax on my SSDI overpayment if I already paid tax on the disability insurance benefits for the same period of time?

T & P:

If I got $15K LTD from Unum and now I was awarded SSDI, the most Unum could ask back is $15K – is that correct? STD was paid by employer.

Attorney Greg Dell:

T & P,

Your assumption seems correct if Unum only paid you 15K. They may not be entitled to the full 15K. Unum will offset your monthly benefit as you move forward so you will not have an overpayment. You may want to consider a lump sum buyout of your Unum disability claim (read here about lump-sum buyouts).

DP:

I’m waiting for my SSDI hearing in June. My LTD contract states that they will offset for SSDI and SSDI dependent payments, but my ex now says he is filing for a child support offset in the event I am approved for SSDI. I’m already living at about 50% of my pay as compared to before the accident, can both the LTD company still claim the offset for the dependent payments received from SSDI if my ex also receives the offset?

I’ve heard that some judges are not allowing LTD companies to take the dependent offset because these amounts are to be designated only for the care/wellbeing of the child(ren) or placed into a savings account for them. Is this true?

DP:

I have another question, sorry.

I paid my LTD as post tax deductions from my previous employer so my benefits have been non taxable. They (LTD) will want any back-payment turned over to them.

I’m told that I will be responsible for paying a large amount of taxes on the money that they will receive, not me, is there any way around this?

I’m having a hard time accepting I paid for my insurance, that they (LTD) harass me monthly, I have to repay all of my backpay and that for my children, then end up with a huge tax bill on top of it.

And, at the rate things are going, my oldest may be 18 before anything happens so the back-pay will go to him in that case. Are there any other options?

Attorney Greg Dell:

DP,

The carrier will still take the full offset for SSDI benefits regardless of who gets the SSDI funds. Please see Can a disability insurance company claim an overpayment for social security disability benefits payable to a child as result of the parent’s disability?

Attorney Greg Dell:

DP,

Another good question. I think you can find your answer by reading Do I have to pay tax on my SSDI overpayment if I already paid tax on the disability insurance benefits for the same period of time?

Penny Jones:

Greg,

My husband has been getting LTD from Hartford for 20 months. I know they are going to tell us to pay them back once he gets SSDI. However, I read our LTD contract and I feel like their own wording should suggest that their LTD payments a PLUS his “other” income (which is how they list SSD) plus employment income (which he has none, he is not working) still does NOT meet the 80% of his pre-injury income. Which is when the contract states that they will reduce his payments.

Does this make sense to you? He is supposed to be guaranteed to make up to $6,700.00 per month, total, without losing his LTD, so how can they count his SSDI at $2,000.00 per month and their LTD at $2500.00 per month as 80% of his pre-injury income (which is how they word their right to reduce their payments)? It’s double talk and I don’t think their policy is giving them permission to reduce his LTD.

Thank you for your help.

Attorney Greg Dell:

Penny,

You may be correct in your review of the policy. Every policy has different language and it is not automatic that SSDI benefits have to repaid to a disability insurance carrier. I have not seen your policy so I cannot specifically comment.

Nelly Frisk:

I am on long term disability right now with Prudential. I’m applying for SSD because it will be more than my monthly LTD benefit. If I win my SSD case, do I have to give any of my retro award to the long term disability carrier? Will LTD cease altogether, since it will be less than my SSD?

Thank you,
Nell

Attorney Greg Dell:

Nelly

Yes, you will need to give back any overpayment that equals the amount you received from Prudential. You may still be entitled to a minimum payment from Prudential.

Doug:

Greg,

I was on short term disability from my employer starting 2/8/2011. I was then transferred to long term disability on Oct. 1st 2011. Insurance company had me apply for Soc. Sec. Disability in December through Allsup. I was just notified last week I was approved back to August 2011. I have received a check for $15,050 for back pay. My question is, will I have to pay back all the LTD plus the short term for 2 months? In 2011 my company was using Aetna as our disab. provider. In Jan 2012 they switched to Sedgwick. How do I work this out with 2 different insurance companies? LTD was a benefit from my employer and I did not have to pay for it.

Attorney Greg Dell:

Doug,

The STD policy may not have an offset provision for SSDI payments. Each carrier may have their own separate claim for an overpayment. They can only request an overpayment equal to the amount that they have paid you. Good luck with Sedgwick as they are usually a nightmare to deal with.

Grace:

Attorney Dell,

I recently contacted an attorney and I am in the process of filing bankruptcy due to my drop in income since I went off work, first on STD, then to LTD and now, ultimately being approved for Soc. Sec. Disability. I have accumulated many bills and medical costs. Can the repayment to my LTD insurance company be included in my bankruptcy ?

Attorney Greg Dell:

Grace,

Great question, but this is a very specific bankruptcy question that needs to be addressed to a bankruptcy attorney. I think that the LTD carrier will continue to offset your check each month for the SSDI repayment regardless of whether you file bankruptcy or not. Please let us know what you find out from a bankruptcy attorney.

A. M.:

Hello,

I moved from one state to the next. My medical insurance can’t be used in the new state so I had to find a Dr. that works on sliding fee scale. I found one but there are no fee scales for specialists. I have severe anemia, need 9 blood transfusions. A tear in my right shoulder can’t get surgery because I can’t get medically cleared. I get lightheaded and shortness of breath, chest pain, just from walking 20 feet. I can’t lift anything because of my shoulder and can’t reach above my shoulder level. My back is weak and I was diagnosed with spinal stenosis.

My new Dr. has yet to send for my records. After 6 months my long term carrier has requested a form to be filled out about my disability. The new Dr. didn’t fill it out as of yet today and the LTD said she is closing my claim. I have 7 kids to provide for. My husband’s income is very small. I also suffer from depression but couldn’t get an appointment until May 7th. That seems so far away. I was a state correction officer, I paid into this Ins. for about 8 years and I am not trying to take anything from them, I cannot work.

I don’t know what to do. What can I do? I asked the claim specialist to give me more time until my insurance is approved so I can go to the Drs. I need and she was very cold and said there is no time.

Attorney Greg Dell:

A.M.,

You need to immediately file an appeal if they have denied your claim. Once you file the appeal, the claim will go to someone new.

Karen:

Greg,

If a LTD carrier sends you a letter demanding an offset amount along with a worksheet showing how they calculated the total amount due, and it turns out they made some errors in their calculations, can they come back later and demand more once you pay them the full amount they requested? I sent my LTD carrier my award letter from SSDI along with another award I received and I think they made an error in their calculations. Can they later ask for more after they were sent what they asked for?

Attorney Greg Dell:

Karen,

They could ask for more at a latter date, but it is unlikely that they would as they would close this investigation and move one. I periodically see MetLife go back and do an audit of any errors that made in calculating the SSDI overpayment. If you get a letter with their explanation of the overpayment, then I think that you would be safe in relying on what the disability company told you.

Doug:

Greg,

Thanks for responding to my earlier question. And thanks for the warning about Sedgwick. I did receive a letter from them for the overpayment. It also said they would deduct any future payments to recoup the overpayment. Once my LTD ends can the sue for the balance? I read an article that due to Erisa laws that an insurance company cannot sue you on employer sponsored plans.

Thanks

Attorney Greg Dell:

Doug,

The courts are divided on this issue. The simple answer is that Sedgwick could sue you, but they may not be able to recover. I think you should take a look at a recent disability court case in which the claimant was sued and ordered to pay back benefits.

Ray:

I’m receiving SSDI and recently took a bad fall down a stairwell do to poor maintenance and injured my back, arm and leg. If I filled a law suit and won a judgement, would I lose my SSDI benefits?

Thank you in advance.

Attorney Greg Dell:

Ray,

In most instances a personal injury recovery will not jeopardize SSDI benefits. If you had a private disability policy, then the carrier may claim an offset for any recovery that you receive. You need to clarify your question with your personal injury attorney.

Dennis:

I recently won a SSDI award and received a back payment for several months, less the attorney fee. My LTD company seeks “overpayment” from me which is OK, but they want to include the attorney fee in the amount owed them. Is this legal? Seems like I should only need to pay them money that I actually received from SSDI and not what I received plus the attorney fee?

Lanette:

I left a position at a company due to my disability at the age of 64. They had a LTD policy and I was approved for a monthly check of 60% of my pay. I had to apply for SSDI and that was approved also. The amount I am receiving from SS is just from my earnings.

My question is what happens if I take the larger amount I am due from my husband’s earnings while receiving the LTD? Can they use that money to offset their payment further?

Jake:

I had an accident a few years back and have limited use of my right arm. I have a part time job but does not pay enough for me to live off of, what are my chances of being approved for SS benefits?

Attorney Greg Dell:

Dennis,

You are correct, the attorney fee should be deducted from the overpayment that you owe to the disability carrier. Which insurance company will not deduct the attorney fee?

Attorney Greg Dell:

Lanette,

The disability carrier will offset your benefit for an SSDI payments that you receive as a result of your disability. It is likely they will consider your husband’s earnings as well.

Attorney Greg Dell:

Jake,

If you earn more than $950 a month you will not be eligible for SSDI. Additionally, in order to qualify for SSDI you must be unable to work in any occupation for which your have experience, education or training.

Michelle:

My LTD terminated my benefits in Feb. 2011 after and ALJ denied my SSDI. I immediately requested that the review board assess my file which was sent back to the ALJ and was approved OTR this month. The judge listed my disability start date as Jan. 1, 2011 instead of the date I stopped working which was 10/1/2009.

I just received a letter from my LTD company stating that since I am approved I must honor the promise to repay from any back payment I may receive from my SSDI. I’m going to request an accounting log showing all payments I have received on their LTD claim because I was still working part time the first 3 months before I was placed on full disability so the payments fluctuated. But my backpay will not cover this time either way.

Since they terminated my benefits based on my SSDI denial a year and a half ago (even though their policy states they have different criteria) can I request that they reopen my claim and pay benefits back to the date they terminated?

The LTD letter states “You have signed an agreement to reimburse *** Assurance Company 100% of any backpay you may receive from your Social Security Disability Claim as repayment for the amount you have received from us beginning June 26, 2009.” But, I’m assuming I will only receive back pay including Feb. 2011 through present during which I have not received any LTD. It may even be less than that if they start the 6 month waiting period in 2/2011, I haven’t received any paperwork yet.

The back pay that they are requesting should only be from the date of onset of the SSDI benefits through the date they terminated my LTD benefits, correct? This would be nothing, or one month’s benefit reimbursement at the most.

Thank you.

Attorney Greg Dell:

Michelle ,

You would only be responsible to repay the disability company for any period of time that overlaps with the same time period that SSDI and the disability carrier pays you. You will need to explain in writing you situation to the disability company.

Tajauna:

How does overpayment work if your SSDI is more than LTD monthly payment? Just been awarded SSDI and received LTD from Dec 11 to June 12.

Attorney Greg Dell:

Tajauna,

You should still be entitled to receive the policy minimum, which is usually $100 a month or 10% of the monthly disability benefits that you qualify for.

Mary:

I have been receiving short term disability beginning October 2011 and have not had any earnings since that time. I filed a complaint with my employer and am now going to be paid backpay from October 2011 through the present. Will I have to pay this backpay to the disability insurance company? I really was disabled while I was out of work and was receiving disability benefits.

Attorney Greg Dell:

Mary,

The answer to your question depends on the Deductible Income provision of your disability policy. You need to review your policy and contact your employer to ask if you will have an overpayment.

Dawn:

Another question that I haven’t quite been able to find the answer to on you site. I have called a few accountants and they don’t know either. I paid my disability as a voluntary after tax deduction from my paycheck so my benefits have been non taxable to this point. Basically I bought into their group policy, but I did so from my take home amount.

So, when I receive my SSDI back-pay and I have to send 100% to the LTD company, is there any legal statute that I can notify them of that allows me to pay taxes on that amount before I send them the remaining? Otherwise I will have to send them everything and still pay taxes essentially being penalized for doing nothing more than paying a higher tax rate up until two years ago by purchasing my policy with after tax dollars. No one has the answer to this. Thank you.

Attorney Greg Dell:

Dawn,

I think you can fine the answer to your question in the Tax Issues section of our FAQ section.

MP:

I received a letter from my LTD company saying that they require repayment of 100% of back pay. But my SSDI is going back to the date of my injury, which was 3 months before my LTD kicked in. I was reduced to 15-20 hours a week from 3/2010 through 11/2010 and my LTD only covered partial benefits from 6/2010 until I was terminated at the end of Nov. 2010, when their benefits were increased. If there is a 6 month waiting period shouldn’t I only have to reimburse them the actual partial benefit amounts they paid me for Sep., Oct., and Nov.? They say they are supposed to get 100% of the back pay because it is less than the total they have paid me over the last two years. Is this right? I thought they could only take the actual amounts they paid to me on a monthly basis for the months I receive both SSDI and LTD.

Attorney Greg Dell:

MP,

I agree with you. They should only be entitled to an overpayment for periods of time that overlap with when the carrier paid you. You need to write them and explain your position.

Mary:

If I’m in a valid repayment plan with AutoOwners for a lump sum I received from my employer while receiving disability from AO, can they put the amount I owe on my credit report? I’ve been making all of my payments on time but am concerned they may turn it over to a collection agency or mess up my credit, even though they allowed me to enter a payment plan.

Attorney Greg Dell:

Mary,

Great question. Most creditors can report whatever they want to a credit agency. Whether or not they can legitimately report is something that you need to speak with a credit attorney about. If you get a good answer to this question, please let us know.

Lisa:

I applied for LTD Lincoln Financial, Wow what a company full of *** nobody I myself faxed 90% of all my own labs a and tests. Denied, so me being sick and tired of being pushed around not only by them but my company as well, being told im not disabled just dont want to work, I got myself a lawyer. Its now been 15 months since I’ve been off work. I am now living on no income borrow money from my parents and other family, I’ve had 2 surgeries and am expected to have another in 2 months, I have applied for SSDI 6 months ago and still havent received anything from them either. I had a car accident 2 years ago in which I have not settled either. I rolled my retirement into a 401into my bank then because I didn’t want to lose my house I paid it off with my 401k. My question is I want a settlement, I dont want to deal with these people every month and I dont feel if I ever do get a payment they should be me entitled to a penny. They didn’t pay me a dime for all this time and I’ve lost my vehicle had utilities shut off, stress from just dealing with them. Why should they be entitled to something of mine. I worked for my retirement and I will be sick for a very long time. As far as my accident that should be mine as well since thats not what caused me to become disabled. My SSDI claim hasn’t even been approved yet either. I lost my cobra when I couldn’t pay their $800 premium so now I have huge medical bills, my medication is around $1500 a month and I also support 3 children, I am a single mom. Please tell me how its fair for them to hold my LTD and collect interest for this long and expect me to pay them, why cant I deduct the interest for the amount of time they denied me till we settle?

Jennifer St Jean:

I see there are too many questions to go through but the majority are not of the nature i’m in need of an answer…

I worked for HP for 15 years and paid heavily into all options, including LTD and SS… I was let go on May 29, 2009, which is the onset date SSDI determined my disability date.

I am diagnosed severe depression, anxiety, bi-polar, and PTSD. Some of which date back to 2006.

Is there any way, ie. via my long term disability company coverage (unknown statute of limitations), or legal action for discriminatory lay-off against that I may redeem this situation when I was unable to rectify untreated at that time?

Regards,
Jennifer

Attorney Greg Dell:

Lisa,

If you have not received any funds from SSDI, workers comp, or your auto accident claim, then it does not seem reasonable that Lincoln Financial should be able to hold your long term disability benefits. You may need to file an ERISA appeal or lawsuit in order to collect your disability benefits.

Attorney Greg Dell:

Jennifer

Most long term disability policies require a claimant to make a claim for benefits within 12-18 months. It would appear that your claim would be untimely and that the company would not consider it. You have nothing to loose by contacting your old employer and trying to submit a disability claim.

Bryan:

My wife was awarded SSD. She collected from Unum Ltd., they want the whole amount of the award paid back. What happens if it is not paid back? We live in PA.

Attorney Greg Dell:

Bryan,

Unum can sue your wife if she does not pay back the funds and Unum can offset her monthly benefit each month.

Tommy:

Dear Greg Dell,

I have a question that does not appear to having been asked as of yet.

Back in May of 2010, due to a childhood illness, my kidneys failed. I worked for 13 years prior for a great firm. I was approved for STD and then after 26 weeks was approved for Long Term Disability through my company’s Plan Hartford. I was only on LTD for 15 months after receiving a kidney transplant from my great brother. My question to you is, during that time on LTD I was asked to apply for Social Security benefits, but I never did. I was terminated from job while on LTD, which I am no longer receiving as I am healthy and able. But my concern is, can Hartford sue me for benefits reimbursement that I never applied for through Social Security?

Thank you very much for your time.

Sincerely,
Tommy

Attorney Greg Dell:

Tommy,

Since you never applied nor were approved for SSDI you should not have any problems.

Chris:

Greg, I am UPS driver in SC. I started in 1994 and in 2007 tore my L4/L5 discs in my lower back. I have been receiving LTD, provided by MetLife, but after 60 months according to them, my LTD is over. I still am unable to go back to UPS as a driver and am still employed with them. For the past two months, I have received no money and at this point, keep getting the runaround. I have filed for SSI and every year denied, because I received to much money. I have filed with the ADA through UPS, but was told this could take months. While still out of work, is UPS not responsible for paying my benefits?

Thank you for your time!

Attorney Greg Dell:

Chris,

I am not familiar with your agreement with UPS. There is no state or federal law which I am aware of which requires UPS to continue paying your benefits more than 5 years after you become disabled. Do you agree that your LTD with MetLife should end after 60 months? If the policy pays for longer than 60 months, then maybe there is something we can look at for you to see if we can get MetLife to pay you longer.

Lorelei Sharman:

I am so glad that I found your web site. It has answered so many questions for me.
I have spent days trying to get answers from SSDI, the insurance company that has payed me LTD for two years and the third party company that filed my claim with SSDI. I have received my back pay (deposited into checking) yet recieved NO paper work ahead of time to expect the funds. Long story short is that I have been told by the insurnce company my back pay is theres.
I thought they were pulling a fast one. I have called my employer to check the offset clause in the policy and await the return call. It is heart breaking to be told you will get these funds and then at the end find out the insurance company gets it all. I am facing homelessness and yet I have thousands of dollars in my account I cannot use to secure a place to live. Your forum is the best source of info I have gotten. Thank you very much for all your caring time to those of us that are blowing a round in the wind. Lori in MD

Sharon K.:

CIGNA LTD has been trying to kick me off after being on LTD for 24 years. I provided so much medical proof that they finally quit on that, but now are requesting 8 years tax returns. My CPA doesn’t want to provide 8 years just because he doesn’t want them going out that many. Not because I worked, but the returns were very long and complicated with my husband and real estate, so the CPA does not want us to provide all of them. My residency has been SC, Fl, and CA. Do you know the statute of limitations in those states and whether I have to provide 8 years returns?

Also Cigna finally gave me a copy of my policy and I saw that they have been supposed to be paying me 60-70% of my gross salary. I know for a fact they have only been paying me 55%. I had argued that when I first went on but did not know I could ask for a copy of the policy. Can I make them pay this back pay? Or what about forward? My former employer who the policy was through has been defunct for over a decade. Please advise what I could do.

Attorney Greg Dell:

Sharon,

You can sign a form for Cigna and let them request whatever tax returns they want. You don’t need to gather them all. If Cigna owes you unpaid benefits, then you can go after them for all of the benefits they owe you. If you can get a copy of the policy from either Cigna or your former employer, then we can review it and let you know if you have a valid claim for unpaid disability benefits.

Troubled & Disabled:

Hello. I was approved for SSDI after many appeals. My LTD carrier has demanded an overpayment of over $50000, which includes a portion of my now adult child’s benefit. My disability being in 2007, my child turned 18 in 2008. I was approved in 2010. The child’s benefit went directly to my adult child. I received absolutely no money or any statements since the child no longer lives in my home. Totally understand if the child was a minor and I received the money. Any advice?

No where to turn:

My wife has been on LTD payments from The Hartford since 2008. We are having financial issues and have been thinking about cashing out her company paid retirement (not a 401k, but company retirement). Is there a way Hartford can verify that this withdrawal took place, outside of me telling them?

Attorney Greg Dell:

Troubled,

If your child is getting the SSDI funds as a result of your disability, then it does not matter where he lives or how old he is. The carrier can only claim an overpayment for any funds they paid you which overlap with the payment of SSDI funds for either you or your child.

Attorney Greg Dell:

No where to turn,

It is possible that the retirement cash may appear on your tax return. Hartford has the right to ask for your tax return at anytime and you would be required to provide it. If they asked you about any other sources of income and you lied, then you could be subject to insurance fraud. Depending upon the policy language, the retirement funds may not be considered an offset. Also, if the income goes to a spouse, then it would not be considered income to your wife. We can discuss some options if you contact us.

Troubled & Disabled:

Greg – Thanks for your response. Could you please clarify the following in your answer:

The carrier can only claim an overpayment for any funds they paid you which overlap with the payment of SSDI funds for either you or your child.

Since they did not pay me the money, it went directly to my adult child, can the claim I owe them the money?

Thank you in advance.

Attorney Greg Dell:

Troubled & Disabled,

They can go after money paid your child if he is receiving benefits as a result of your disability.

Susan:

I was on LTD for depression and the policy was for 2 years. I used about a year and a half of LTD payments. I then got SSDI. I got a letter from insurance company that I owed them $24,000. This was in May 2011. I have not heard from the insurance company since about Sept. 2011. There have been no legal filings and no contact.

Two part question:

Will I eventually be sued for the money?

I have declared BK Chapter 13 in June 2010. I did NOT place them on the list as I was not approved for SSDI as of yet. Can I file BK 7 and include them now?

Alison:

Would the LTD company have a copy of my pay-stub or other information showing whether I had paid premiums for 70% or 60% at the beginning of my disability about 20 years ago? They are claiming they do not have that info, but they did give me the sheet that shows they only paid me 55% when the policy said they would have to pay me 60-70%.

Attorney Greg Dell:

Susan,

They could potentially sue you for the money. If you declared bankruptcy I don’t think it is dischargeable, but it would be very hard from them to collect from you. I cannot answer questions about bankruptcy as I don’t know about bankruptcy laws.

Attorney Greg Dell:

Alison,

It is unlikely the disability carrier would have the info you have mentioned. Your former employer may have that information.

Becky:

Do you know if Unum will allow me to repay my overpayment by withholding my monthly payment from them?

Attorney Greg Dell:

Becky,

In some case you can work out a repayment plan with them.

Whippowill:

Just got a letter from my LTD provider wanting to know if my wife is going to file for early retirement for a spouses portion of my SSDI or if she intends to file for her own retirement benefits when she turns 62 in a few weeks. Why are they asking these questions?

If my wife begins receiving her own social security benefits that she earned will that offset my LTD monthly benefits, also what if she were to receive a spouses part of my SSDI would that offset my LTD monthly benefits. They didn’t offer any explanation as to why they want this information. I don’t understand what business it is of theirs if she files for her own social security benefits early. Can you enlighten me?

Attorney Greg Dell:

Whippowill,

If you wife receives any SSDI payments as a result of your disability, then the disability carrier will attempt to further offset your monthly check. Your wife should obtain benefits which have nothing to do with your disability claim and then it will not impact your monthly check from the disability carrier.

CoCo:

I have been recently approved for LTD through my employer group insurance. I have been through the elimination period and have started receiving benefits. My employer accepted a letter of absence which stated I requested an “undetermined length of time” while going through medical procedures. I have been through many procedures that have not been successful. My husband recently was offered a position in another city which would require us to move. How would this affect my LTD since I am presently just on a leave of absence from my work?

Attorney Greg Dell:

CoCo,

In most disability policies as long as you stay within the US, then you can move without a problem. You must continue to receive medical treatment wherever you move to. The disability company will ask questions about why you moved and possibly try to use it against you as a reason you stopped working.

Susan:

I have been collecting LTD from UNUM and have just been approved for SS disability. I know that I must reimburse UNUM the amount I owe them. This is my question – I may also be eligible for widow’s disability through social security. If I am approved, must I also report that income to UNUM to offset their payment to me even further?

Thank you.

Attorney Greg Dell:

Susan,

The widow benefit is usually not a deductible source of income. Can you get both SSDI and the Widow Benefit? If you cannot, then you may want to waive the SSDI benefit and just take the widow benefit so that you do not have an offset.

Sharon:

I settled a work comp claim out of court, but never received any worker’s comp, just a lump sum settlement. Will I have to pay back MetLife Long Term Disability?

Attorney Greg Dell:

Sharon,

It is probable that MetLife will seek an overpayment from you.

Daniel:

Why don’t you lawyers get together and file a class action against all these ripoff insurance companies, hit them where it hurts. Just reading all these emails you get, its pretty apparent that this is a real problem in this country. I for one am in the same boat as these people. For one thing… I saved the 4 page pamphlet they sent me to sign up for this LTD policy, it doesn’t mention any of this in it, at best vague and misleading. On it I only agreed to let them take money out of my paycheck, I never agreed to all these terms. In the policy it says I will get a minimum of 100 dollars a month. They can use that for payback, that or settle with me… $1200 a year times 25 years, take it or leave it… or come down here to my county, sue me, get a judgement that they cant collect on because  own nothing, and they cant garnish my SS, because I’m disabled. Tell me what you think.

Attorney Greg Dell:

Daniel,

It is unfair that the disability companies can offset your monthly benefit with SSDI payments, but it is legal. The disability company can sue you for any overpayment, so you need to be cautious. They cannot garnish your SSDI payments.

Been Denied LTD:

Dear Mr. Dell,

Because of people like you, it has given a lot of us disabled people a reason to continue the fight against bad denial disability carriers. You’re obviously one of the largest firms in the US and are very brave to have videos and so forth and I’m certain insurance companies despise your presence.

I can only say thank you. But, until the ERISA law is reformed the fight is not over. The problem is ERISA and I’m sure you’ll agree it is broken. It should allow in bad denial cases for you to sue for recovery of any financial losses you have incurred and it currently doesn’t. ERISA, which was written in part due to insurance fraud, has now been turned into a profit maker for insurance companies to deny any claim for any reason. Obviously, they will be cautious which they choose as they don’t want to attract government attention to those practices.

However, I think it’s safe to assume at this point that the carriers are drawing an enormous amount of attention to themselves as of recent denying claims in record numbers. What is be doing at the Supreme Court level and DOJ about this practice? I think were beyond the point of lawyers and fights. Were now at a national problem that ERISA is the problem and it’s being abused by insurance carriers for what the law was intended to do and that’s curtail fraud. But now they have abused that privilege. Don’t you think it’s time the DOJ and Supreme Court and Congress lay the hammer down on this issue? People are dying from this!

Kathy:

My long term care benefit has been reduced by my SSDI payment amount. The premium my employer paid for LTD was based on a benefit of 60% of my wage when in fact I’m only receiving about 30% from the insurance company. Doesn’t seem right or ethical you pay a premium based on a benefit you expect to receive, then they can manipulate your benefits based on “deductible income”. I think they should refund my employer’s premium to better reflect their payment or I should receive the full 60% of my salary plus SSDI. Are there any lawsuits of insureds going after these insurance companies?

Attorney Greg Dell:

Been Denied LTD ,

The battle against ERISA starts with elimination of discretionary clauses, which is happening at the state level. More than 15 states have passed new laws making the discretionary clauses illegal. This is a strong step in the right direction and gives claimants the best chance to prevail if an ERISA lawsuit needs to be filed. The Supreme Court hears an ERISA based case every two years, but I can tell you that they are currently not interested in abolishing discretionary clauses or adding punitive damages as a remedy. The Supreme Court seems to lean toward the insurance companies when it comes to ERISA.

Attorney Greg Dell:

Kathy,

The action by the insurance company reducing your benefit by SSDI is legal and enforceable if the language is contained in your contract. It is not fair, but legal.

Janice C.:

I hope my question makes sense, here goes.

Back in 2000 I was in a severe car accident I was getting long term disability through MetLife. They had me apply for social security disability. With the understanding if I was approved, I would offset amounts for what they paid me. I was approved for a set amount of time. In which I paid them back. However, my daughter was also awarded a large amount of money and MetLife took that as well. I believe after all was said and done I received chump change back from social security. It has been almost 12 years since this happened. I guess you learn more with age. And having to file for disability again I’ve learned a few more things.

So my question is, can anything be done, because it was so long ago? And if it can, where do I begin?

Thank you.

Attorney Stephen Jessup:

Janice,

If your question is with respect to the amount of money received by your daughter from the SSA on account of your disability (dependent Social Security) and whether MetLife has a right to any of that money, the answer is: possibly. If your MetLife policy indicated dependent Social Security as a deductible source of income, then any award for same to your daughter would be MetLife’s to claim repayment of for any period of time you receiving the dependent SSDI benefit and a benefit from MetLife. From a practical standpoint – it has been over a decade so I would not expect that MetLife would come knocking on your door demanding the money. If your question is with respect to the continuation of a benefit from MetLife (as you indicated that you were approved for a set amount of time, I am assuming the benefit was terminated), the answer is most likely no, as deadlines and statute of limitations with respect to filing appeals or lawsuits would have expired.

Michael:

Dear Sir, how far along will Prudential keep making me appeal to the SSA?

So far I’ve been denied by the SSA Judge at a hearing. Then Prudential hired Allsup to get a copy of the Judges denial, they are still paying me LTD benefits. Now Allsup is calling and they are asking for Prudential to see proof that I’ve affected an appeal to the appeals council in Falls Church, VA which my SS attorney recently did file. I’m told now we have to sit back and wait. I hear it can take up to a year just for the appeals council to begin reviewing my denial from the judge. This Judge has a low award rate for those applying for SSDI benefits, is a mean Judge.

What happens if at the appeals council level I’m denied? Will Prudential make me go further to federal court or start an application all over? What happens if I don’t want to appeal further? Will Prudential stop my LTD payments just for not continuing further?
I have a very good ERISA law attorney, a super lawyer. Any thoughts are appreciated.

So far Prudential has paid me 3 years out of work. The entire first year out of work Prudential wouldn’t pay me anything. So I hired an ERISA attorney and that appeal letter had them paying up 4 weeks after they received it, my attorney must have upset their cart of apples?

Thank you,

Liz:

Dear Mr. Dell,

My girlfriend is on the long term disability from an employer’s insurance company. In the near future she might be entitled to large inheritance. She is worrying that the insurance company will stop paying her benefits and also they will go after the funds to offset retroactively. She has been on the long term disability for 5 years due to injuries at the workplace. Can they really do that?

Thank you in advance for your answer,
Liz

Attorney Greg Dell:

Michael,

In order to answer your question, we would need to review your disability policy. Since you already have and ERISA attorney this is a question that you need to ask your attorney. We have dealt with this issue many times and we are usually able to get Prudential to stop requiring after appeals once a hearing has been completed. Hopefully you will win your SSDI claim. You may want to get away from Allsup and hire a good SSDI attorney. We can recommend an SSDI attorney if you need one.

Attorney Greg Dell:

Liz,

Inheritance will not likely offset her disability benefits, but we would need to see the disability policy offset language in order to confirm.

Michael:

Mr. Dell,

I appreciate your reply. I understand what you’re saying about usually you’ve been able to get Prudential to stop requesting further appeals be done past the ADJ hearing for SSDI. Maybe it doesn’t stop Prudential from initially still pushing anyway to have a claimant on LTD keep appealing beyond the hearing? I’ve applied recently to the appeals council stage and have to sit back and wait up to a year now I understand, I hear it depends on the appeals council “unit” I’m assigned to in Falls Church, VA as to how long it will take,some units maybe have less case loads then other units? I apologise if I wasn’t clear. I have an ERISA attorney and a lady SSDI attorney. What is happening is apparently Prudential still hires Alsup to gather information and make phone calls for them on their own behalf. Like they had Alsup call and get a copy of the ADL’s denial letter and then they asked Alsup to get proof of me applying to the appeals council. I didn’t ask directly the question to my ERISA attorney how far Prudential can demand I keep appealing to the SSA yet.

But, no I know better then to have Alsup doing things for me directly that’s why I have both an ERISA and a SS attorney. It seems odd that Prudential contracts Alsup to do things for them like make a phone call and ask questions only, you’d think a case manager at Prudential could do these things on their own?

Thanks again,
Michael

Ken:

My wife went on disability from work in late 2007 and was being paid LTD by the insurance company until 2010. In 2011 she was awarded SSDI and was paid a large lump sum and monthly payments began. The lump sum money was used to pay medical bills, living expenses, etc. and attorney fees. In late 2012 she was served with a lawsuit against her from the LTD insurance company. It is an ERISA case, we are told. If the judge finds in the Insurance Company’s favor, can her SSDI monthly payments be garnished going forward to repay the ‘overpayment’ they are claiming?

Attorney Stephen Jessup:

Ken,

If the policy allows for an offset of your wife’s benefit by SSDI benefits and there is an outstanding overpayment resulting from the lump sum SSDI benefit, then the carrier does have the right to collect. That being said, I am not aware of any cases where a judge determined that her future SSDI benefits could be garnished to pay back the insurance company. Quite often the company will send the claim to collections in an attempt to recover owed money.

Elle J.:

If my LTD company was supposed to pay me the difference between my monthly LTD benefits and my monthly SSDI benefit, but they have not done so for three years because I owe them back pay after being approved SSDI, wouldn’t the payments they were supposed to pay me for the difference offset the amount I owed them in back pay? In other words, for example, if my LTD monthly benefit was 1000 and I was approved for 600 monthly for SSDI, then LTD would pay 400 monthly. However, hypothetically, I owe LTD 5000 from SSDI back pay so they never paid the 400 monthly payment difference. Now it is three years later. Therefore, 400 (monthly LTD not paid) X 36 months (Length of time since SSDI approval) = 14,400. Theoretically, LTD has recovered my SSDI backpay and then some since they never paid me the difference between my monthly LTD benefit and SSDI for three years. Is this correct? It seems they would actually owe me money at this point. Correct? And now, my employer no longer uses the same LTD company, so when I try to contact them, they have no record of my claim and tell me to contact my employer. Of course, the amount LTD says I owe them in SSDI is on my credit report, but I feel this should be labeled as settled. Any advice?

Attorney Stephen Jessup:

Elle,

Under your hypothetical it would appear they owe you money, or at the least your overpayment repayment satisfied and benefits should be issued. The only suggestion I have is to look for an old correspondence from the insurance carrier that has your claim number on it so when you call they have a reference point from there.

Barbara:

I have a two-year LTD benefit with MetLife, which I have been collecting since March 2012, to end March 2014, due to a med condition which forced me to retire from the Fed Govt after 30 yrs of service. Of course, the disability benefit is now offset by my pension payments, but I will soon receive a monetary court award of $40K, gross, due to a slip and fall suffered in 2009, unrelated to my employment and current med condition for which I am currently collecting LTD payments. Is there any way MetLife can construe this monetary award as income and request an offset, even though it arises from an unrelated slip and fall which happened three years prior to filing my disability claim?

Attorney Stephen Jessup:

It will depend on the language of the policy. As it is unrelated to the disability it would seem they would not be entitled. Normally any subrogation rights under a policy for any type of accident/injury case are limited to when your disabling condition is a result of that accident/injury. So if you had been in a car accident, hurt your back and then made a claim for disability benefits based upon the resulting back problems then the carrier would have a potential claim on any recovery from an ensuing settlement. However, refer to the language in your policy- it can normally be found in the “Other Income Benefits” provision.

Kim:

I was awarded SSDI for Lupus and Sjogren’s Syndrome. I have Liberty Mutual as my LTD carrier. I paid back the back money I was awarded for me and Liberty takes the monthly income out of what they pay me. Recently, I was also awarded dependent care and got back pay for that. I understand that insurance companies can claim that money for me, but Social Security made me sign papers saying I would only use the dependent care for my kids. Paying back my LTD benefits is not for my kids. How can it be legal for them to require me to pay anything back from dependent care when it is clear that Social Security stipulates that money only be used to provide care for my kids?

Attorney Stephen Jessup:

Kim,

Unfortunately, many (if not most) ERISA provided group disability policies enumerate primary AND dependent social security benefits under the policy. If your policy indicates that dependent social security benefits are an offset under the policy then Liberty would be entitled to repayment of the money they have forwarded.

John:

I started receiving LTD 3 months ago, I was 64 and 8months old. The insurance company ask me to apply for SSDI, I have and been turned down for the first time, I filed for a review. My LTD will only be paid for 2 1/2 years due to my age and my company’s policy. What happens if I don’t get approved by SSDI after the 2 1/2 years and I file for SS? Will I have to pay back the over-payment? I am also having a hard time seeing what advantage winning SSDI at my age would be, if I get paid my LTD for 2.5 years I will be age 67 before I fife for SS and my long term payment from SS would be more than if I received SSDI now plus the lawyers fee’s. Can you help?

Denise C.:

I am inquiring for my sister-in-law… she has been on LTD through SunLife for 2 years and has recently completed her “every 2 year review package” to continue her LTD. SunLife told her that they overpaid her $40,000 because she was also collecting SSDI.

When she was approved for SunLife LTD during her initial process the information was provided to SunLife regarding SSDI. We have explained to SunLife that this was an error on their part and that we understand the monies are owed as they have been overpaid, but need time to pay back.

They are not willing to work out a payment plan, only payment in full. They are willing to settle for a buy out. They would pay her approximately $120K over the next 10 years until she was fully retired at 65, so they offered $65K less the $40K owed… to pay $25K now. What are her options in payment.

In reading your comments, it appears as if SunLife does not need to offer a payment plan, but this seems as if this was intentional to force a buy out.

Cindy:

I understand the part about the long term disability company getting paid back because of “double dipping.” What happens if the back pay I receive from social security isn’t enough to cover all the money owed? Does my LTD carrier garnish my social security payments until the debit is repaid?

Attorney Stephen Jessup:

John,

There isn’t really an “advantage” to you winning SSDI benefits at your age, the advantage is to Unum as they can offset the benefit. However, if you don’t go through the Social Security appeal process (as required under the policy) then they can estimate the benefit and reduce your monthly benefit by the amount they determine you would get- which is a definite disadvantage to you. If you do not receive SSDI benefits prior to the cessation of your Unum claim, the Unum claim then ends, and you begin drawing your normal social security retirement benefits then Unum should have no right to those.

Attorney Stephen Jessup:

Denise,

Unfortunately, even if it was Sun Life’s error they do have a viable claim for the over-payment of benefits. If she cannot work a repayment plan with them there stands a chance they would deny her claim and send her to collections. Offers for buyouts are often strong arm tactics to close out a claim. Please feel free to contact our office to determine how we may be able to assist. However, from the facts as provided, any assistance we may be able to provide might be minimal at best.

Attorney Stephen Jessup:

Cindy,

The back benefit amount received from SSDI is almost always sufficient to cover any over-payment owed. Please note that if you used an attorney to obtain SSDI benefits, any attorney award paid to the attorney at the direction of the SSA will not be counted as part of the over-payment calculations by your insurance carrier. The LTD carrier would never garnish your SSDI payments, but would rather reduce your monthly benefit until any over-payment is satisfied (if the company is willing to do so).

Dianne:

If I received a lump sum from SSI for my child and used the money to get move into a better house and by a car to get back and forth to work with. The question is can they take the check because they say that they want cover what I spent the money on?

Attorney Stephen Jessup:

Diane,

If your policy indicates that Dependent Social Security Disability benefits are an offset under the Plan (and most ERISA based group disability policies do) then the carrier is entitled to recovery of the money paid to your child on account of your disability.

Melissa F.:

I saw this question further up but, can I get you to clarify please? Or to make sure I understood.

How does taking a lump sum payout from Retirement Account affect future Long Term Disability Payments? In other words if it is a one time lump sum, they can only take an offset for the one month that it was received in, correct? They cannot use that amount retirement money to offset future Long Term Disability payments, correct?

Of course on the other hand if retirement account is being distributed monthly then it would be a monthly offset just like SSDI is, correct?

Attorney Stephen Jessup:

Melissa,

It depends on the language in your policy. If Retirement benefits are considered “Other Income Benefits” that are allowed to be offset under the Policy, then the carrier will certainly reduce your monthly benefit. Some policies indicate that if you receive a lump sum receipt of “Other Income Benefits” then it will be prorated over a period of time into monthly payments. In essence, no, it might not be considered as received only in the month you receive it. One thing you need to consider is if you pull money from a Retirement Account early (besides any possible penalties for doing so) and the insurance company can reduce what they pay you by the amount you take you’ve effectively lost money as the money in your retirement account won’t “be there” for retirement.

Rose H.:

I have a question about long term and short term disability along with SSDI. I was in a car wreck in 1992. After many surgeries and rehab, I was rewarded SSDI because of the lasting effects of the accident. I also received LTD payments through Mutual of America. Needless to say, it did not amount to much.

Years later, I went to college and obtained a few degrees. I wanted to get back into life and work. So, I went through the SS work program. I informed the LTD policy holder about the job through the program. They did not cut the benefits. Anyway, just 12 months into having a job, my artificial knee dislocated and is causing me a whole new set of trouble such as nerve damage and vascular issues, not to mention the knee is messed up. I have been off of work for 2 months now. My doctor said I can not go back for at least another month and then he said “we’ll see”. Through the employer, I signed up for USAbility long term and short term disability. My employer just today sent me the form for the disability insurance (short term).

My question is if I apply for either short term or long term disability, will it interfere with my social security benefits. Also, can they off-set my SSDI even though I received it prior to getting the new policy?

Attorney Stephen Jessup:

Rose,

You will need to review your policy to determine if SSDI is an enumerated offset. There is case-law that would suggest that the carrier can reduce your benefit by the amount you are receiving from SSDI benefits awarded prior to receiving benefits under a LTD policy. Another issue you may have is the fact that you have only been employed for 12 months at the current job. Depending on the effective date of coverage under the LTD policy, your claim may be considered pre-existing for purposes of LTD benefits.

Paul:

Please help.

Here are the facts. I am disabled on LTD from MetLife. My son became disabled on Nov. 2011. He draws SSDI of $800 since I am disabled and $200 due solely to his SSDI. He became 21 on April 2013. My wife is his personal representative.

Son got back SSDI of $9,000 retroactive and social security wrote a letter saying this was totally from his SSI. Later they may have re-classed to it to regular SSDI. Not sure about this the confusing offsets they speak of. The SSDI payments pay for his living expenses and I see no benefit. We have claimed him as dependent on tax return for 2012 and prior.

Per LTD Policy MetLifecan reduce my LTD by any payment my dependent receives or assumed to receive, because of my entitlement to dependents benefits. Dependent includes any person who receives benefits under any applicable law because of my LTD benefits. Insurance company will reduce amounts of my ltd by any amount paid to my dependent.

Here are my main two questions:

1. Is my son my dependent? Since he is now 21 (not able to attend school), I can elect to not claim him for 2013 tax return. Would not claiming him help us us on LTD offsets from age 21 and forward?

2. Since he did not receive any cash or even know if he qualified for SSI/SSDI until he was older than 21, do you think I am obligated to notify MetLife that my son is receiving benefits? I don’t want to get in trouble for deception.

Thank you very much for your time.

Attorney Stephen Jessup:

Paul,

First and foremost, if he is receives any amount for primary SSDI in his own name due to his own disability, then that amount should not be used as an offset by MetLife.

With respect to question (1): Any questions having to do with claiming him for tax purposes is a question you need to address with an accountant. However, dependent SSDI benefits on account of your disability are likely not tied to you listing him as a dependent for tax purposes. Dependent benefits are usually cut off at the age of 18, so it might benefit you to speak with a SSDI attorney as to that.

As for (2): You are only responsible for letting MetLife know what your son receives on account of YOUR disability, not for his own under a separate claim with the SSA.

Susan V.:

I retired at 42 and have received a monthly retirement pension. I started to work for another company a year after I retired. Now at 54 I become very ill in February 2013 and have been on STD for 6 months. They are turning this over to LTD at the end of August 2013. This is my question. The form I received stated if I received any income from the policyholder which is my current employer and I also added to this by 5% of a deduction to increase my LTD benefits. My question is this – after reading the verbiage the policyholder is my current employer and would not include my past retirement that I was receiving before I took this current job. Will this be considered income? I am so confused not that I have read all the above. I also want to just roll over my 401K to a different financial institute not withdraw the money (will this also be a problem?). It seems that STD and LTD are so much stress on top of being sick. Thanks.

Attorney Stephen Jessup:

Susan,

Without a review of the language in your policy we would not be able to answer your questions regarding potential offsets as other income. Please feel free to contact our office at 1-800-682-8331 to determine how we may be able to assist you.

Charlotte:

My husband is on long term disability with MetLife. We may or may not receive a settlement with his former employer through the EEOC. Can MetLife garnish the whole settlement? If we can make this a “pain and suffering” pay out only, would that keep them from claiming this money?

Thank you,
Charlotte

Attorney Stephen Jessup:

Charlotte,

The only way to know if MetLife would have rights to any settlement would be contained in the “Other Income Benefits” provision of the policy. I can’t recall seeing in any policy indication that a suit against an employer is considered “Other Income” but I would have to defer and refer you to the policy.

Tony:

Good Morning,

I started receiving early retirement at 62. I went back to work and stopped the early retirement. I am now 64 and on STD, which lasts 6 months. After 6 months, I am required to apply for LTD. I am also required to apply for SSDI after 6 months. They will hold any social security benefits against me and reduce my check by that amount.

But I cannot receive disability because I already took some early retirement, correct? And they cannot force me to take early retirement again because it will all be subject to repayment for being over income? Can they force me to take retirement at 66 or even before?

Tony:

I bought credit disability insurance with a loan in 2008.

I was diagnosed with cancer in 2013. However, it was Stage 3a. It has been present for a long time.

The symptoms of the cancer started in 2009, and are clearly documented in my medical record. I did not work in most of 2009, all of 2010, and most of 2011 because I was disabled by the symptoms.

However, between 2009-2013 I saw more than 10 doctors for these symptoms, none of who could properly diagnose my illness. It was misdiagnosed over and over again. It is a rare form of cancer than can only be diagnosed with certainty by cell pathology and a bone marrow biopsy, which were not done until 2013.

I am trying to get the credit disability insurance pay for 2009-2011, and maybe now since it is the same illness which was not properly diagnosed before. They will not pay unless it arose while I was insured.

What should I do in this situation? The doctors are not totally cooperative because they are worried about their malpractice liability.

Rich Barnum:

I have a LTD policy with Aetna that and is offset in part by SSDI, the amount I get from this ERISA policy is pretty decent. They have been paying me for 3 years with no problems and have been approved even past the higher standard after the first two years. My condition is not likely to improve and is not life threatening. My question is “What would trigger to company to offer me a lump sum buy out?” and “At what point do they usually start to consider doing this?” With the low interest rates, I would doubt they would be very motivated to settle. What are your thoughts? Thanks.

Attorney Stephen Jessup:

Tony,

With respect to the SSDI question, you would have to consult with a Social Security attorney. I don’t see how the carrier would be able to force you to tap into your retirement again. Have you made the company aware of your situations?

Attorney Stephen Jessup:

Tony,

Without your doctor’s support it could be very difficult to obtain the information needed to prove to the carrier your disability arose at a time when you were insured under the policy

Attorney Stephen Jessup:

Rich,

Aetna will consider lump sum buyouts of claims, but it is not a universal, across the board consideration. They offer them on limited cases. You can contact our office to discuss your claim further to see how we may be able to assist you in securing a buyout.

Debbie Trujillo:

I recently received a lump sum back payment from Social Security. I had to give most of that lump sum back to my employer’s long term disability insurance company. Am I responsible to pay taxes on that amount I gave back to the insurance company?

Attorney Stephen Jessup:

Debbie,

Unfortunately, as we are not tax professionals, we cannot give any tax advice. I would advise you to speak to an accountant.

Adam Mills:

I was injured working for CSX and was receiving short term disability (Railroad Retirement Board) that was not taxed being that it would have to be paid back after settlement. Also received advances on settlement through claim agent that was not taxed being also it would have to be paid back after settlement. Also received Aetna payments that WAS taxed and turned out also had to be paid back. My question is that I had been paying taxes on the Aetna, and after the settlement the gross was paid back including the taxes that I had already paid back. So I paid back again the taxes that I already paid like I was double taxed on the money? Is that right?

Attorney Stephen Jessup:

Adam,

Unfortunately, as we are not tax professionals, we cannot give any tax advice. I would advise you to speak to an accountant.

Tony Stocker:

My question is a simple one I think. I have been receiving SSDI since 2004, and also LTD from my company that I worked for). When I reach retirement age and my LTD stops, will my SSDI increase by the amount that I was receiving from my employer’s insurance company for LTD? Thanks in advance.

James:

I am new at this disability stuff. But I don’t know what or if I can do anything. Just let me say what a can of worms this disability is, feels like I have a bag of cats in my head.

I was chagrined, when I found out that I basically have no pension plan. That if I collect my pension then my LTD carrier will scream offset. It seems that their logic is faulty. Social Security states, that my collecting my pension plan, it has no bearing on my benefits. It does not considered pension plans an offset.

If my LTD carrier does not offset my savings account, but yet calls my pension an offset. I get it, all those other offsets, but my pension plan. It appears to me that, which I noted on day one, that they have the final say on absolutely all monies until I am off LTD. Now that is what I call power. It makes since about receiving pay for working why that is an offset, my pension is not money I worked for, in a manner of speaking, but monies I saved for and is not gift by my employer. This pension plan is not a disability retirement. So, effectively I have no pension plan. It is not a fee for services payout.

Is there anything, I think I already know the answer, that I can do? Also this LTD is a plan I paid all premiums, my employer paid nothing.

Attorney Stephen Jessup:

Tony,

The answer is no. SSDI is a set benefit amount and does not increase (outside of applicable COLA increases).

Attorney Stephen Jessup:

James,

Most ERISA based group disability policies provided by an employer will indicate a Pension plan as “Other Income” that can be used to offset your monthly benefit if you decide to draw money from it. Unfortunately, this is completely legal. If your policy in-dicates as much, then there is nothing that can be done from a legal stand point. I would suggest that you obtain a copy of your policy to review of this language is contained.

James:

Thank you for your answer. But I am a little confused. My employer only gave me STD. The LTD was a private policy I paid for. My pension plan is not a Disability Retirement Policy. I received nothing from my Pension for disability. Nor is there any clause in the retirement policy that covers disability. So, when you say “group Disability Policy provided by my employer”, do you mean that my employer provided coverage and LTD benefits. Because that never happened.

So, for sake of argument, let say my retirement is not as you described, then does that change the out come of how my retirement plan is viewed.

Thanks again
James

Attorney Stephen Jessup:

James,

Again, you will have to review the language of your policy. If it defines the pension as other income benefits then they can reduce by.

Alisha Allen:

I’m am receiving SSI disability and payments from long term disability insurance UNUM. Now UNUM wants to collect the back payment from SS for my child. The payment was deposited in her bank account and SS told me that they will be monitoring how the money is being spent. I explained to SS about UNUMs request to collect that back payment and the supervisor from SS said absolutely not I cannot give it to them or else I would be committing fraud. UNUM is very nasty on the phone with their threats and stressing me out. I’m not sure what to do. I feel like whatever I do I’m screwed.

Attorney Stephen Jessup:

Alisha,

If the plan indicates dependent social security as an offset under the policy then they are unfortunately entitled to seek repayment of same.

Donna:

I live in CA, and I am being paid through Unum. I am waiting to be approved through SSDI. My question is, can Unum get some of the back money that the government owes me?

Attorney Stephen Jessup:

Donna,

You will need to review your policy to confirm, but if it is an employer provider group disability policy, then chances are you will owe an overpayment.

Daron:

Does a LTD Ins. Co. have the right to remove your calculated wage rate? My contract states 60% of weekly salary. Also, can LTD Ins. Co. change my job description / title / duties in order to find a job that they can list as employment I qualify for but, with a greatly reduced salary? Can they legally do the aforementioned and terminate my benefits? If my benefits were terminated and through the appeal process they were re-instated, does the LTD Ins. Co. owe me back pay from the day they wrongfully ceased my benefit pay to present date?

PO in Texas

Attorney Stephen Jessup:

Daron,

A carrier will determine what your “pre-disability earnings” were based upon the definition in the policy. Sometimes this does not include overtime, commissions, bonuses, etc. Additionally, most definitions of “own occupation” are defined to mean how your job is performed in the national economy and not how it is performed for your specific employer. If your policy contains any of the above language, then yes, they can legally make appro-priate adjustments to same. If your claim is denied and then reinstated on appeal you will be due all unpaid benefits from the date of the denial.

Cheryl:

I worked in a hospital and I kept getting sick. I had no more sick time or vacation days so I quit my job. I tried to ask other people but I had no help. I was paying for short term and long term diability. Now it’s 5 or 6 years later and I better. I fought for my diability in 2011 and won. I left my job in may 2008. Can I do something to the insurance co. for the money I put into their company?

Attorney Stephen Jessup:

Cheryl,

It is unclear as to what assistance you may need or what the nature of your questions is. Could you please elaborate?

Alan Smith:

I was injured driving a bus for my company in 2010. My work comp payments stopped in February of 2013. And I was terminated for being absent from work for too long of a period. I’m still taking meds for back pain. I’ve been informed by my attorney, that the insurance doesn’t want to agree with the terms of the Medicare set aside arrangement. So we are goin to trial in 30 days. I’ve had two back operations and the last one, which was a lumbar fusion, they never approved of and it was paid by Blue Cross. Their offer is $67,000, which sounds ridiculous to me saying that they won’t agree with the set aside request. I’m writing because they want me to withdraw my application from social security or their not willing to settle. I’m worried if I won’t receive anything if I go to trial, because I hear so many people telling me that I should settle because its possible that I won’t receive anything if I go to trial. So I’m dealing with 27 days left of worrying… Please help.

Attorney Stephen Jessup:

Alan,

Unfortunately we do not handle SSDI or Worker Compensation claims so I would not be able to shed any light on the subject. I would refer you to your attorney for your questions.

Don:

I am on long term disability with Productional and was found I am having seizures and my licence was taken away. I am getting very depressed being stuck in the house. I can’t walk for more then five minutes and I live in FL which, due to the sun, also causes more issues. I live in a trailer home community area and was wondering is there any program that allows me to get a gulf cart that has an overhead cover to allow me to go to community stores and help me with a lack of freedom issues causing me to be so depressed? Meds are not helping at all and have tried different ones with my doctor.

Attorney Stephen Jessup:

Don,

A private disability insurance carrier would not have a program like that, but you may be eligible under a government sponsored plan from Social Security.

Karen:

I was approved for disability through SS, but MetLife has turned me
down for Long-term disability. They said they see no reason I can’t
return to work. I have Follicular Lymphoma, which is not curable. The
normal remission is 2 years and the cancer returns. I have been going
through treatment for almost 2 years, and continue to do so.I have
also been diagnosed with extream fatigue, Fibromyalgia and anxiety.
Should I try to appeal…or, am I wasting my time with MetLife? Thank you!

Attorney Stephen Jessup:

Karen,

In my opinion, it is always worthwhile to appeal the decision, as the MetLife disability benefits are something you are entitled to. Please feel free to contact us if you would like to see how we can assist you.

Linda:

I am considering going out on LTD due to multiple back and heart problems, but want to totally understand what I’m getting myself into as far as future payments. My LTD plan indicates that retirement income which I could receive (whether or not I have applied for and am actually receiving the income) would be used to offset any disability payments under the plan. I am 57 years of age and could technically retire from my company at age 55. However, if I don’t retire and start taking my retirement benefits until age 65; the monthly benefit amount is almost double than it would be if I retired right now. The LTD disability payments will only be made until I reach age 65. At that time I will only have my Social Security and retirement benefits to live on. My question is whether or not the LTD company can force me to take retirement now instead of waiting until I’m 65 when the retirement benefit would be much more.

Attorney Stephen Jessup:

Linda,

First and foremost, no one would ever be able to help you totally understand what you would be getting yourself into when it comes to applying for long term disability benefits, as there is no such thing as a guaranteed disability benefit. Should your carrier approve your claim, there is no guarantee that they will not as some later point deny it. With respect to your question about drawing retirement, please review the language of the policy. Most only require you to apply for Social Security disability benefits, but do not require you to dip into a retirement plan early.

Evelyn:

I receive LTD & SSD my LTD as offered me a settlement which I think is too low considering what I would get if I keep collecting it monthly. I don’t know what to do. Would love some expert input I only have a week to make up my mind. Thanks!

Attorney Stephen Jessup:

Evelyn,

Please feel free to contact us to discuss your options and how we may be able to assist you.

Gary:

The language in our CBA States: the above other income benefits, must be payable as a result of the same disability for which the plan pays a benifit, so for the last 7 years my ex employer and the steelworkers Union have been fighting just to get it to arbitration, I went on Ltd for one reason and SSDI for another reason, so in layman’s terms, to you does this contract clause mean that no offset should have been applied!

Attorney Stephen Jessup:

Gary,

You may very well be correct. There is caselaw for and against this proposition, but it is definitely something worth pursuing.

Linda:

Stephen,

Thank you for your reply. I stated in my question that my LTD plan document does state that the retirement income would be used to offset the LTD. It says it would use retirement benefits I am eligible for whether or not I am actually receiving the money. It doesn’t make sense to me that they could offset LTD benefits for money I am not receiving. It seems from reading the LTD plan document I would be forced to apply for retirement, which I am eligible for at age 55, or my LTD benefits would be offset to a point where I wouldn’t have enough money to live on.

Attorney Stephen Jessup:

Linda,

I understand your concerns over your predicament and although no one can predict what the carrier will do, I have not personally seen an insurance company offset a benefit for failure to apply for retirement benefits.

Sue:

We have an unusual problem. My husband has maintained a very costly top of the line disability insurance for 25 years, as he is a surgeon. It covers “decrease in pay” in the event of a disability that makes your current job impossible, even though you are able to work and not SSI level disabled, but would work in a different field with a lower pay scale. Well, now at peak earning age, a recent health problem has cast doubt on continued ability to practice at current level, but would be totally fine with another job with some fewer demands, but less salary would result (I hope that makes sense). For someone who regularly works 80 hours a week, even normal work is a decrease. We would consider getting “loss of income due to job change” payments if health worsens any more and he needs to cut back. We looked up our policy and found that it was no longer active. We had simply stopped getting regular communications from the company and did not miss them in time. Are we liable for not noticing that they did not send us our statement, or are they liable for not sending us a statement? We have paid big money for 25 years, I am wondering if they were thinking this was a sneaky way to cut and run from a long time customer as he approaches that age where things start to go wrong (50s). Obviously we can’t get “new” insurance now due to the existing issues.

Attorney Stephen Jessup:

Sue,

Missing a premium payment could obviously result in your husband forfeiting the policy. If you have not already done so, contact the carrier to discuss what options he may have to reinstate the policy as most policies do have provisions for same in the event of a missed premium payment.

Solomon:

My SSDi application has been approved and got the back pay within a few days. My son was also eligible and applied within a week of my approval and got approved. However, my wife who was eligible doesn’t want to apply. My question is that can my private long term disability insurance force my wife to apply for benefit?

Even though it is not fair, I am not arguing for including my son’s payment as a source of income to offset their payment. What I don’t understand is that how can the insurance try to offset an income that neither I nor my wife has received?

Attorney Stephen Jessup:

Solomon,

The answer as to whether or not your carrier can “require” your wife to apply will be contained in the Policy, most likely under the section for “Other Income Benefits” or in a section referring back to it. The language of many policies will indicate that failure to apply for a source of “Other Income Benefits” could result in the carrier estimating what the amount received would be and then offsetting your benefit by it. Please note that they cannot force your wife to apply, but failure to do so could have an adverse effect on your benefit amount.

Solomon:

Thank you for your helpful tips. I am kind of angry as I don’t have control over my wife’s refusal to apply but as a result I am going to pay a price.

Vanessa:

How about taking a loan against your 401k, would that be counted as deductible income for LTD insurance purposes? Since, I know it does if you take out your 401k but with a loan, I will be paying it back.

Attorney Stephen Jessup:

Vanessa,

A private loan from an institution should not be considered a deductible source of income. That being said, I would refer to the policy language to see if that scenario is addressed (though I suspect it won’t be).

Concerned:

This may have been answered but not sure. I receive tax free ltd benefits from insurance company, and they want me to apply for ssdi. If I do so, and am awarded, I will be offsetting taxable income (SSDI) for previously tax free income. In addition, my lump sum will be taxable compounding the issue (costing me tens of thousands of dollars). I have no incentive to apply and/or win (other than appease carrier, which is important obviously). What to do?

Attorney Stephen Jessup:

Concerned,

Unfortunately there is no finite answer to your questions and is a subject we have addressed with the carriers.

George:

I have worked at employer for 25 years and I have gotten terminal ill. Employer had short and long term disability insurance. I had applied for short term and was approved then applied for long term and was approved. After 2nd month of long term the company wanted a note from doctor stating how long I would be off. The doctor sent them a letter starting the treatment would last 48 weeks. The company said they could not hold my job that long and they were going to terminate me. I have applied for SSA and still waiting for SSA decision. I have been drawing LTD from insurance co 6 m.o. after the company let me go. Will I have to pay the insurance co back whatever they paid me since I was fired? I know they will get the offset. Wonder if my coverage was to be terminated after they fired me or being I had a claim it will carry on until I get my SSA approved.

Attorney Stephen Jessup:

George,

If you were on disability at the time you were terminated, you are still effectively covered under the disability policy and will not have to worry about paying the insurance company back any benefits you were entitled to after the time you were formally terminated from your company.

Concerned:

Stephen,

Thank you for your response to the above. I see that you’ve addressed it with the carrier (outcome?), but has anyone challenged the taxable/tax exempt offset in court? Thank you again.

Sara:

My social security disability decision was found favorable after 5 years which has left me with a large overpayment. Since the decision has taken so long to take, my children have both turned 18 and they want to give them each part of the backpay. If I had the disability at the time I wouldn’t have had to go through my grandmother’s inheritance and the selling of my house. This seems unfair. They are both still immature and irresponsible on top of that. Is there anything I can do to stop this from happening?

Attorney Stephen Jessup:

Sara,

Unfortunately, if the policy allows for the offset of your monthly benefit by any amount received by a dependent/family menber from the SSA on account of your disability there is very little that can be done to prevent the carrier from collecting same.

Johnny:

If I owe an overpayment to a Group LTD plan because my ex wife filed (without my knowledge) for dependents benefits. She is the custodial parent and declares them as dependents on her taxes. When the LTD carrier discovers this they will declare an overpayment. I have lost everything, including my last home. If the carrier wants to be paid back, can I file bankrupcy and avoid paying the overpayment? I purchased another home and have $20,000 equity plus a 2008 vehicle (paid for). Can the carrier take my home and vehicle? I was recently released by my PCP and am physically able to work. Have been on SSA and LTD for 6 years. I didn’t think a carrier could go after my personal assets. Are my SSA benefits safe?

Attorney Stephen Jessup:

Johnny,

With respect to filing bankruptcy to absolve any overpayment your insurance carrier may assert, you will need to speak to a bankruptcy attorney. I have not seen a situation where an insurance company goes after personal assets or SSDI benefits in order to satisfy an overpayment. Usually, they will garnish your benefit or send you to collections. A bigger concern would be that your doctor is of the opinion you are physically able to return to work, which could prompt your carrier to deny your benefit all together.

Kim:

Here is an example of my letter regarding “release of medical information”. What are you thoughts? Will they try to cancel me because I want to protect my privacy?

Dear Disability,

I am writing on behalf of my husband,

Regarding the medical record release for Paul. He will sign medical authorizations that are specific to the medical providers you would like records from. Paul is concerned about signing general authorizations. We will cooperate, but Paul wants to protect his privacy.

If you would like any other records, please send specific authorizations.

Sincerely

Terry:

I was of the understanding that since my LTD was through the company I worked for I was protected by ERISA from being sued by LTD company for overpayment by SSD.

David:

I had a traumatic work related injury in June of 2011, I immediately began receiving Workers Compensation payments. Prudential started paying me Long Term Disability in November 2011. I was approved for SSDI two weeks ago and have received back pay back to September 2012. Prudential has only paid me the minimum amount of $100 minus $25 for taxes, so I only see $75 a month. SSDI monthly amount is $438. If I am correct I should only owe Prudential $1500 for the claim during that period. The back pay amount was over $6000. I am just trying to understand it.

Attorney Stephen Jessup:

Kim,

It is similar to letters I have drafted and/or encompasses the nature of specific releases I drafted for each individual doctor. I would suggest that you send the letter certified to have a signature confirmation that they received it, as paper trails are crucial when dealing with an insurance company.

Attorney Stephen Jessup:

Terry,

Unfortunately, there is no expressed portion of ERISA that protects you from same.

Evelyn:

What does LTD over payment mean? I settled with lump sum, am I at risk for this over payment? Thanks.

Terry:

If I wait a few months before letting my LTD company know of my SSD award will I get in legal trouble for waiting?

Kristina:

I started receiving LTD this past April 2013, I filled the paper work back between october and november of 2012 and had stated I was on workcomp at that time. In April of 2013 when my LTD became active I held onto the first check because I was receiving workcomp still and I didnt cash any of them in fear of a over payment. I called my workcomp and the hartford and spoke with both agents and they both stated it was a OK! to cash em all. My LTD agent was in talks with the workcomp agent to find out all the dates and so forth that I was and still receiving my checks. Yesterday the LTD agent calls me out of the blue after 5pm and told me that there was a impact to my claim and a error on their half. He proceeded to tell me he was not aware I was receiving workcomp checks and was under the impression from the email from the workcomp agent that my work comp had stopped back in aug 2012. I’ve told him that he was wrong and that I had spoke with him numerous times and informed him only pay I was getting was workcomp along with their LTD checks. Now their threatening with a overpayment and so forth. This has stressed me out beyound stressed.

Attorney Stephen Jessup:

Terry,

If you mean criminal legal trouble – no. However, waiting will affect the amount of any potential overpayment due back to the carrier.

Attorney Stephen Jessup:

Evelyn,

If you settled your claim then most likely there was a mutual release between you and the insurance company, meaning you both waived any rights you may have had, or would have under the policy. If so, then there would be little for you to worry about. If you were represented by counsel in settling your claim I would suggest you confirm with him/her.

Attorney Stephen Jessup:

Kristina,

Unfortunately, Hartford may still be entitled to recovery of any overpayment even though it appears to be their fault in not assessing it earlier.

Evelyn:

Thank you. I didn’t have representation and I couldn’t find any lawyer that would take on this type of case, so I had to go it alone & hoped I was doing the right thing.

Antonio:

I am receiving LTD benefits.

I was required to apply for SSDI, and I was approved. The awarded was retro 2 months.

Those two months of back pay were withheld, as was part of my first check. I was previously receiving early retirement and I exceeded the maximum earnings. Thus I owed SSA $6000 which they recouped before paying me anything.

My LTD policy has an offset. I am not sure how to explain this to them and if I should. I am afraid they will try to recoup money from me that I didn’t actually get. Can they say they can offset amounts that were never actually paid to me and were kept by SSA?

Kristina:

Hi just trying to figure out, Hartford called claiming impact to my claim and a error on their part and then stated a huge amount of over payment but I went back and added up what I was paid from them and basically their over payment is the full amount they’ve paid me so far. So I’m at a loss where in the books is this over payment and what their error was. They’ve told me I will be getting a letter in mail from them explaining more but I was so upset and distraut that I basically told em I need to think and hung up. They’ve called me Wednesday and today is Monday and still no letter. My LTD is not working hand and hand with my workerscomp and not sure how to get them working together and on the same page.

Attorney Stephen Jessup:

Antonio,

I would assume that your carrier is offsetting your benefit by the amount that you receive from retirement. As such, they should be aware of any potential issue that may arise with the SSA benefit and any offset as to same.

Attorney Stephen Jessup:

Kristina,

You will have to wait until you receive the letter to determine what, if any, overpayment there is. As Worker’s Compensation and Long Term Disability are two separate benefits most likely administered by two different companies, it may be that they never get on the “same page.” When you receive the letter, please feel free to contact our office to discuss the alleged overpayment.

Antonio:

To follow up @Antonio

I received the retirement benefits before I went out on disability. I paused the retirement when I went back to work. They do offset retirement, but in my case they did not because I wasn’t receiving it at the time. I don’t know If they knew I ever did. Does this make a difference?

Also I was just approved for disability credit insurance to pay off an old debt from 2008 (five years later). They agreed I was disabled in 2008, looking at my medical records for that time. They will also give me a small amount going forward. MY LTD will offset this however.

My concern is that my LTD has a pre-existing condition exclusion. They can exclude me if I received treatment for my disabling illness 3 months prior to when I was hired. I did not. My illness was not properly diagnosed until a few months ago. I had minor symptoms that one could argue might when been related as early as 2008, but not consistently, and doctors disagree if there is even a relation. Before I started my job however, (during the exclusion period) I was not being treated for anything related to my disability. Even the company’s doctor found nothing abnormal, nor did my personal physician. The company thoroughly medically evaluated me prior to hire, and neither they nor I suspected any medical problem. Still I worry that they may try to find an excuse to deny me. How do I handle this?

Should I hire/consult an attorney pre-emptively or wait until I have a problem? Do I have to pay the attorney upfront or do they get fees when the insurance company loses?

Thanks.

Attorney Greg Dell:

Antonio,

You have asked a lot of questions. Depending on the facts of your claim, we may be able to assist you without any fees up front. In your case it seems like you may have multiple offsets which may wipe out any potential LTD benefit payable to you. The pre-existing issue will vary depending on your policy language and how long you had the policy before you filed a disability claim. We always recommend disability claimants to speak with a disability attorney at the initial stages of a claim in order to avoid any future problems. Contact us to discuss your claim.

Fred:

I am receiving disability payment from UNUM, I have been working a part time job and they are aware. They deduct from that source of income monthly, if I make more or less they calculate it. My question is, can they deduct any money that I receive for mileage (wear, tear & gas) & cellphone reimbursement? My job entails me to drive to meat consumers & using my cellphone to call & receive calls. Please advise me.

Thanks.

Attorney Greg Dell:

Fred,

Unum may be able to deduct your reimbursements, but you should deduct your expenses each month from the income that you are reporting to UNUM each month. This should help you to receive more money each month by reducing the income you earn.

Confused in Houston:

I recently quit my previous job in September and instead of rolling over my 401k I withdrew it in a lump sum ($2600 after the fees and taxes). I just received a letter from Prudential saying I received an overpayment of $1200 and they want me to pay it back! How could this be when it’s my own money in my 401k and not theirs! I already paid them the fees associated with taking the lump some so how could I owe them about half of what was already mine?

Attorney Stephen Jessup:

Confused,

You will have to review your policy to determine what constitutes “Other Income” for purposes of offsetting a disability benefit. In some cases if the 401(k) funds were originally in a company sponsored Retirement Plan then the carrier may deem it “Other Income.”

SJ:

I was just approved for SSDI. I also get LTD from UNUM. OF course, they want my back pay now. What happens if I use that money to pay my outstanding bills? Can I set up payments with Unum? And will Unum charge interest? Because my payments right now with everyone else are high interest and a lot more. I am trying to weigh both and see which will be better to do, but do not want to get into trouble for doing something wrong. I used Genex, and I assume part of this money belongs to them? Although they say it was a free service? All of this just seems like bull, because no one told me about this last year, they encouraged me to get SSDI, and now that I have it, they are taking all my back pay. Thanks.

SJ:

As well, I just looked up my account on the UNUM site, and it lists all the correspondence, and I looked at the letters from 2012, and I do recall now, I picked Option A on that form to have SSDI take from my check, and then the rep calls me and coerced me into picking Option B, and I have mental issues, and I did not understand even what any of this was about or the repercussions of any of it, so I went with what she was saying. Then, I got the letter confirming that she changed it to Option B. So that is on record.

Then, just a few months later then they call me and tell me I have to go on SSDI, and that Genex will be repping me. I just feel ripped off. I just wonder if there is anything I can do, as I really did pick Option A, and there is the letter there to prove that was my original choice before I was talked into the other option by their rep. Anyways. Any help?

Attorney Stephen Jessup:

SJ,

Unum might consider a repayment plan (usually they will garnish your benefit check until they recover the overpayment) if you do spend the back benefit check from SSDI. There may also be the option of potentially negotiating a lump sum buy out of your policy that could also address the overpayment.

Attorney Stephen Jessup:

SJ,

With respect to Unum asserting an overpayment, there is very little you can do if the policy allows for it. Had you selected Option A, and it was enforced, Unum would have reduced your monthly benefit by the amount you would have been estimated to receive on account of SSDI. Although it seems unfair, at the end of the day you end up having received the same amount of money regardless of what option you chose.

Kim:

Hello,

I was looking through my policy and I noticed a choice of 2 check boxes. One adjusts offsets automatically and deducts from you benefit. The other makes you liable for any overages in the future. I checked the latter. Could I call and have that changed? I would rather this be adjusted on a monthly basis. We checked box b without knowledge and understanding.

Thanks

Gilbert Guzman:

Dear Sir,

I began collecting SSD on February 2013. I applied on Sept.2010 was denied and I appealed it and won. So in 2013 I began to get benefits. Also, I received worker’s compensation but was terminated on November of 2012 until I went back to court with more medical records and October 2013 got my worker’s compensation reinstated but with temporarily partial payments. On December 2013 and January 2014 from the 1,304.00 Social Security was cut to 645.00 to 545.00. Now I received a letter of an overpayment of 6,000 plus dollars and that the agency will hold all payment until October of 2014. I do not understand how could created a such overpayment when I was not getting workers compensation. I am in more trouble, why I am being punished severely by this agency? This situation will cause an undue hardship to me. Worker compensation will go away any time now. I filled an appeal last week. Is there any other ways to prevent for them to take the whole thing away? I did the math and I think is around 13,000 dollars punishment and I am disabled. Can you help me please, or give advice?

Attorney Stephen Jessup:

Kim,

Based on your prior post, I am assuming that the offsets are already in place. As such, I do not know if you would be able to change the option you selected to have American Life estimate and offset your benefit by other income sources.

Attorney Stephen Jessup:

Gilbert,

Unfortunately we do not handle SSDI claims, so I would be unable to provide you with any guidance other than to suggest you speak to a Social Security attorney.

Paul:

Hello,

I am trying to find out how to contact my LTD carrier regarding the change in the way my overpayments are handled. I would like them taken out on a monthly basis, instead of getting hit with some big “surprise” in the future. Should I call or write?

Paul:

How long will LTD wait until they inform you of any overpayments?

Jean:

Can a LTD insurance carrier deduct both SSDI and Disabled Widow’s Social Security payments?

Attorney Stephen Jessup:

Paul,

The carrier will not know the status of any potential overpayment until they receive information as to same- such as when you receive a notice of award from the Social Security Administration, Worker’s Compensation or from any other source of enumerated “Other Income” in the policy.

Attorney Stephen Jessup:

Paul,

You can certainly call them to inquire as to whether they can estimate your SSDI benefit and begin offsetting your policy now for same. That being said, I am of the opinion that a paper trail is always a good thing when dealing with an insurance company, so I would also follow up in writing.

Attorney Stephen Jessup:

Jean,

The policies typically only reduce for social security benefits based on your disability. The policy should indicate exactly what will constitute “Other Income Benefits” that the carrier can offset your benefit by.

MDB:

I have been out of work after a surgery for almost 8 months now. I applied for and was given SSDI for full disability. MetLife denied my STD because there was a gap in my coverage during the last 4 years of my employment with the company I worked for. I had to send in a statement of health and they denied the coverage. I had and paid for LTD with MetLife since my start of employment and recently applied for the LTD claim. Question while I am out of work, am I still covered if my premiums have not been paid to MetLife? I never received a bill or notice from work that it would be discontinued while disabled.

Attorney Stephen Jessup:

MDB,

It seems like the real concern based on the information provided is whether or not you were covered by the policy in the first place? Did you seek clarification form your HR department to prove you were covered under the policy at the time of disability.

RD:

Simple question. If a disability company takes payment to reclaim the SSDI lump sum payment are they not accepting that the SSDI judgement of disability is in effect? Since their contract creates the relationship surely they cannot later claim that it is immaterial, especially if they have accepted large payment in cash and then subsequently reduced what they claim is their liability to the disabled policy holder under the policy. This is in distinction to any decision made before they assert their right to claim on SSDI payments. In doing all of this have they not created an estoppel that they can independently deny further claims while SSDI is in effect?

It would seem to me either they have created a conflicting standard contra proferentem that should be resolved in favor of the claimant or they should have to refund their now underpayment of the original claim and subsequent payments. How can they invoke binding SSDI commitment on the part of the claimant and then disavow it as convenient? Furthermore, they often attempt to gain privileged access to SSDI information through dubiously “independent” third party SSDI assistance in their pay which they can and will use against claimants. Had they not created this situation they would be in the clear, but they did, and so they should be held to it. They set the standard and took the moneys to back it up thus cementing the relationship.

Attorney Stephen Jessup:

RD,

I would agree with your logic; unfortunately the case law is quite clear that although receipt of Social Security Disability benefits is evidence of disability that an insurance company must consider, the receipt of SSDI benefits, in and of itself is not a guarantee that you will be approved for benefits under a group or private disability policy.

Sue:

Hi Greg,

I just happened to come across this e-mail and hoping that this might help you & others.

I also have The Standard long term disability along with Social Security for me & my children. They came back to me about my kids getting Soc. Sec. payments and that I was over paid. (It was for about 5+ years & would be a large amount of money due back). All the papers stated like you said: kids Social Sec. money is also considered payment. But by a miracle, I had kept my paperwork forms from when I started my job in the late ’80′s (but they still had it in last year). And there was a small line under the kids Soc. Sec. money to be include that stated “AT THE TIME THE DISABILITY STARTED”. This doesn’t happen very often but my kids where born AFTER my disability started. (I hope this might be something that can help someone else because it was terrible going through this).

Good Luck to all.

Steve:

I have a deductible source of income question and it’s technical (I am a former insurance claims litigation director prior to disability, fully versed in policy/coverage interpretation). My policy contains the customary deductible sources of income, including the standard for unemployment benefits. However, my policy contains the following pertinent language: “Prudential will only subtract deductible sources of income which are payable as a result of the same disability.”

Here are the pertinent details to my case. I become disabled in May 2010. Shortly thereafter, my employer laid me off (documented by letter, basically claiming my position was eliminated). I applied for STD and LTD (LTD was denied at first, appealed, and awarded and continuing to date). Prudential took the position that unemployment benefits received were a deductible source of income. I disagree and cite the above language. My unemployment (deductible source) did not “result of the same disability.” When I applied for UC, I expressly stated that I was laid off, and I expressly disclosed that I was disabled, and expressly stated that I could not perform my prior occupation. I was awarded UC in spite of these express representations.

Prudential dismissed my position, and took a long vacation from paying benefits. The amount is significant. It is my position that the UC benefits are the result of being laid off, and NOT the result of any disability.

Do you think I have a case worth pursuing to recover this significant sum? Given that I was just awarded SS disability, and they owe me a significant retro sum, I want to revisit the issue prior to turning over this significant sum. Your thoughts?

Thank you in advance.

Attorney Stephen Jessup:

Sue,

Thank you for sharing. This is valuable information for people covered under group disability policies.

Attorney Stephen Jessup:

Steve,

Please feel free to contact our office to discuss your claim in greater detail. If your policy is governed by ERISA, then the analysis becomes more specific to any potential discretionary language in the policy.

CCD:

My husband received LTD from UNUM for two years (2011-2013). He was recently approved for SSDI with an onset date of Nov 2010. I know we have to pay UNUM back when he receives his backpay but not sure how they calculate it. We don’t know the amount he was approved for yet. But let’s just say he was receiving $2400 per month from UNUM for 2 years. His SSDI gets approved for $1700 and his ex wife gets $850 for the kids. $1700 is less than what UNUM paid him but if you add in what his ex will receive, the total is more. Will he be expected to pay all $2400 per month that he received from UNUM or just the $1700?

Mark Horton:

I received 6 months back social security disability with no taxes taken out for the months 7/2013 to 12/2013 & received it in January 2014. I called the IRS & was told I will be liable for the taxes on that amount. An amount which will put me into a higher tax bracket. Can I negotiate down the 14,123 award from social security down & hold out enough money to pay the tax liability. It doesn’t seem right that I should pay the taxes for money the company will benefit from. Taxes were taken out of the amount of paychecks I received while I was on the company Short Term Disability Program. I never went on their Long Term Disability program.

Attorney Stephen Jessup:

CCD,

Under most policies he would be responsible to repay Unum for any Primary SSDI benefits (those due directly to him) and Dependent SSDI benefits (those received by a dependent on account of his disability) received.

Attorney Stephen Jessup:

Mark,

You will need to consult with a tax professional. The taxability of Social Security benefits is outside the scope of our specialty.

JD:

I have been disabled for 15 years and married for 12 years. For the entire 15 years, I have received both LTD and SSDI. We are now divorcing.

Can income from alimony, assets, or investments reduce (or be reduced by) either LTD insurance or SSDI? What if I get a portion of my spouses 401K? What if I rent out a room in my house for extra money?

Attorney Stephen Jessup:

JD,

You will need to consult with a Family Law attorney to determine the answers to your questions.

Terry:

If I choose to fight repayment of overpayment and lose and subsequently have SS disability garnished, is that monthly amount of garnishment restricted to a ceiling percent of my monthly benefit or could a judge garnish my entire SS disability monthly payment?

Attorney Stephen Jessup:

Terry,

I am not necessarily following your question. If you mean you want to fight your insurance company’s right to repayment and if you lose can the insurance company garnish your whole disability benefit until the overpayment is satisfied- then yes. Typically carriers will withhold paying your monthly benefit until an overpayment is recovered.

Military Wife:

Took my husband in today to apply for SSDI, he was injuried in Afghanistan and I medically retired from the Army. The caseworker told us are benefit amount and told us about the back pay. I brought in his DD214 and all of his medical records. Do we have a good chance at being approved? He has 12 disabilities and rated 60% disabled by the Army, and 70% by the VA. He suffers from Bipolar, anxiety, adjustment, PTSD, right knee tear, left knee pain, back and hip pain and sleep apnea. Thanks for any advice.

April:

If I am only drawing $1213.00 a month from my LTD and I recently got approved for SSD in the amount of $1300.00. Do I have to pay my LTD back the full amount of my back pay or just what they paid out to me? Also, LTD is taxed and SSD is not so, will I be able to file an amended tax return for the last two years in which I have owed state taxes on the LTD? Thank you!

Attorney Stephen Jessup:

Military Wife,

First and foremost, thank you to your husband for his service. Unfortunately we do not handle SSDI cases, so I would have to defer you to a Social Security attorney as it relates to your husband’s chances. If you are having a difficult time locating one in your area, please feel free to contact our office and we can assist in connecting you with one.

Attorney Stephen Jessup:

April,

Under the typical ERISA disability plan you will owe the carrier back all money that they have paid you thus far that coincides to the timeframe the SSDI payment is for. It does appear that there is a difference (to your benefit) in the amount between the two, so make sure the carrier provides you with a detailed breakdown of any overpayment.

Additionally, most policies have a “minimum benefit” amount that is typically $100.00. So even though you are receiving more from SSDI, you might still be entitled to the minimum benefit contained in the policy from your insurance carrier. With respect to any questions as they relate to taxes, you will have to speak to an account or tax professional, as we cannot provide any type of tax advice.

Terry:

Thankyou for the answers and your time, very appreciated. I didn’t word my last question properly so Let me try to do so. If my LTD carrier sues to recover over payment monies by garnishing my Social Security Disability monthly payment to me is there a ceiling percent of that monthly SSD payment to me that a court will allow? Example: my SSD is $1560 a month and overpayment by LTD is $20,000. Would a judge let them garnish the entire monthly amount of my SSD or a maximum percentage of that monthly amount until the debt is satisfied? In other words, would a court allow the distruction of an individual by garnishing that persons entire monthly income (SSD) until satisfied or a percentage of that monthly income (SSD) over a longer period of time…

Attorney Stephen Jessup:

Terry,

The LTD carrier will not garnish your SSDI check in the sense they will intercept it and take it. Instead they will more than likely withhold any check they would send to you until the overpayment is satisfied.

Nancy:

I have been receiving LTD payments for a year now due back surgery which did not help and now have more pain and other health problems. I also contacted chemical meningitis do to a spinal puncture during a radiology procedure which is also causing health problems. Due to all of these health problems I have been diagnosed with anxiety and depression. I received a call from Unitedhealthcare and also sent paperwork that they want filled out by my therapist. The paperwork states they only pay mental for 2 years, since my main health issues caused my anxiety and depression diagnosis can they only pay me up to 2 years? All my doctors confirmed that my health issues caused the mental problems. The Insurance company does put stress on you and they know it.

Attorney Stephen Jessup:

Nancy,

If this is related to a health insurance policy (I have yet to see a United Healthcare disability policy) then I would not know how to advise you. Is it a provision that they will only cover doctor’s appointments that relate to mental health treatment for a periof of two years?

Mario:

Background:

I was a qualified Public Safety Officer in California and sustained a work related injury in December 27th 2012. I began receiving LTD payments in March of 2013 of 66 2/3rd percent of my regular salary, and I used benefit hours from several of my banks to cover the remaining 33 1/3 percent (100% of my salary) while I appealed my W/C claim. In the end of April 2013, an independent medical examiner found that I was injured and that my injury was indeed work related. I settled with the City and retired on August 31st 2013. In our settlement which was approved and signed by a WCAB judge, it states the vacation hours that I used during my absence from work between January 1st to August 31st 2013 should be converted to 4850 time (4850 is full tax free salary up to one year for a Public Safety Officers if they sustain a work related injury and are temporary or permanently disabled). The City reimbursed all of the benefit hours that I had used from my banks during that time period. I subsequently received a cash payout after I retired for those hours that I’ve accumulated in several of my benefit banks throughout my 6.5 year career for the exception of sick hours.

The insurance company is now claiming “over payment” of the hours that were reimbursed by the City and paid after I retired. Those hours were used between the months of March 2013 to August 2013, but ordered by the judge to be converted to 4850 time.

Question #1:
Is the insurance company entitled to reimbursement between the months of March and August 2013, even though my injury was deemed work related, and I was entitled/received 4850 during that time?

Question #2:
Can an insurance policy between the City and the Insurance company override state law pertaining to 4850?

Question #3:
If they are entitled to reimbursement and I pay them back, how do I claim this reimbursement when I file for taxes in April 2014? For example, the insurance company documented that in 2013 they paid $28K of taxable income to me. Two week later, they recalculated the disability payments because I have been receiving PERS retirement payments as well, and stated that I owe them $22K of “over payments”. They are now refusing to adjust the W2 to correctly reflect the amount that they actually paid of $5K once reimbursement is made.

Any advice would be greatly appreciated.

Anonymous:

@Nancy,

I have been going through this process with ERISA LTD claims for 3 years now.

I understand your problems. Let me explain something you need to clearly understand.

The insurance is fully aware of what they do causing anxiety and stress in addition to your physical problems.

Let me give you some very sound advice that I urge to listen to here.

First, they know how to steer your claim into a mental issue. Most policies written by employers have a 24 month clause for mental issues. Although yours is physical anxiety and stress can cause more pain in addition to your physical problems. Insurance companies are aware of this and know how to change your claim from physical to mental to get you disqualified from the 24 months rule.

This means that while you believe your problem is physical. The very fact that you are having anxiety and depression expect your claim to be reversed into a mental one. They know how to do it.

My advice is get your depression and anxiety under IMMEDIATE control, Nancy. Because if you don’t you are only giving them ammunition to uphold your denial and get you disqualified from the 24 month limit so they are doing this now to use evidence against you later.

Get it under control stop seeing a therapist isn’t going to help your claim it will harm it. Seek inner strenth instead and I hate to sound so blunt but focus on your physical problems ONLY a your going to need to grow a pair. There in business to make money and they are immoral in their decision making.

I highly advise you take my advice because later when you hit that 24 month mark in your policy your significantly reducing your chance to rebuke their claims that your problem isn’t physical but more mental to get you disqualified.

Please listen to this. I understand your being honest with your claim of being physical. Hire an attorney put this to rest and get your depression and anxiety out of your medical records for the future of your claim. Let the attorneys like Dell deal with your anxiety and depression and move on with your physical recovery as best as possible. Ok? Do we understand each other that they are structured to deny you from the beginning?

And watch out for PI’s on contract changes. Usually a year prior to you hitting the 24 month mark exepect videos to start surfacing. So just be honest with you claim and realize that getting anxious and depressed is exactly what they want you to do! Don’ t do this get yourself in gear and over this and get out of therapy as soon as you can and hand it over to an attorney. No one will win against them without legal counsel. And I fully expect Mr. Dell to agree with what I said.

I’m going through all this today and it’s nearing an end. Thank god all of you.

Please listen to me they are immoral and will do anything including driving you to insanity to get your case denied on the basis of “mental”. There day of reckoning with your god is coming. And anyone working for them isn’t going to get that free pass if you get my drift. They know what they are doing is immoral.

Attorney Stephen Jessup:

Anonymous,

You are correct, we would agree that if a disability insurance carrier can direct a claim to a condition with a limited benefit period (be it Mental Health/ Self-Reported Symptom/ Substance Abuse) they will most certainly do so. Nancy, please feel free to contact our office should you wish to discuss your claim in detail.

Attorney Stephen Jessup:

Mario,

If the policy allows for the offset of your disability benefit by any amount received by worker’s compensation, retirement or any other defined source of “Other Income” then you could be liable for repaying the carrier. I am unfamiliar with “4850 time,” you will probably need to consult with an employment attorney with respect to any rights you may have pertaining to that issue. With respect to your question regarding the tax ramifications that is something that only a qualified tax professional would be able to answer for you.

Nancy:

Hi Stephen,

The adjuster calls from Unitedhealthcare but her letterhead states Unimerica Life Insurace. This is a long term disability policy I bought at a benefits fair at work, so I paid the premiums through my paycheck. My employer did not pay any of the premiums. This is not health insurance. I get a disability check from them once a month. What I am thinking is that they will try to use the mental diagnosis’s as the primary diagnosis when that is not the case. My primary diagnosis’s are degenerative disc disease, headaches which are severe in nature, chronic back, neck and leg pain s/p surgery and chemical meningitis.

They have sent me more forms to fill out, ie: a headache log, supplemental statement, mental status supplemental questionnaire (for my therapist) restrictions and limitations form (for my therapist) and a activities log for me to fill out to what I do Monday to Sunday (broke down my hours to equal 24 hours)

Thank you so much for listening and for any advice you can give me.

Nancy:

Hi Anonymous,

Thank you so much for your information and advise! I really appreciate it.

Omar:

I have a long term disability (genetic disorder, muscle atrophy) but I am working full time as of October 2012 to now. My questions is since I was not aware of the SSI income and Disability income earlier, can i claim them for the previous years? Please let me know about my inquiry because nobody has guided me and my family on the right path. I would really appreciate all the help.

RJD:

Nancy,

Remember free advice is worth what you pay for it. But I do not agree with Anon’s posting.

The first thing any competent mental health professional does is rule out organic causes. You don’t get much more organic than meningitis. Trying to alter medical records can only blow up in your face. And do not beat yourself up, if you were a burn victim you might be expected to feel a bit badly about it, to say the least. You got burned from inside the central nervous system. It does get any more direct than that. Go ahead a feel as bad as you may, but remember the battle is going to be over how your medically induced restrictions affect your ability to work. The mental health thing is a contractual trap, but one easily avoided by having an organic (physical) cause.

Yes, Disability companies play every imaginable game to increase human suffering in order to boast their own profits. It does not mean that they must always succeed. Get the appropriate specialist, (Internist, Neurologist, Radiologist or Psychiatrist) to document the organic origins of your condition. (In your case you might even look into suing the Radiologist and the institution that allowed the procedure. If you won, your disability case would be a slam dunk. Just a thought). Remember Psychiatrists (but not Psychologists) are first trained as Medical Doctors (MDs) and only then can they specialized further in Psychiatry. They must always consider organic causes first ahead of “mental illness”. (Mind you some of them might be as crazy as their patients, but that is true of all medical practitioners, lawyers, and people who post to blogs…).

Of course when the brain is destabilized physically (organically) nasty consequences follow. That is not mental illness, it is a physical disease state just as surely as if somebody blew half of your brain away with a gun shot leaving any reasonable person with the expectation that you would be expected to suffer negative consequences.

Here’s the basic deal: medically based disability is a three step process, of which only the first step is actually medical. The three steps for proving a medically based disability are:

1. There must be a medical condition identified by a medically qualified (licensed) professional(s).

2. That medical condition(s) must lead to a behavioral restriction or limitation. (Known in the disability field as R & L). The R & L(s) must be recommended and documented by the medical professional as resulting from your medical condition. A restriction is something that you can never do; like if you have a bad back you must never lift more than 10 pounds. A limitation is a lesser ability to do something; like you can only be on your feet for a maximum of 4 out of 8 hours a day. Watch out, the R&Ls are the disabling condition, not the medical condition!!! You can have a 12 inch tail which could be medically unpleasant, but it would not restrict your ability to work. But you could have a bad back or severe neural problems that would preclude from loading a truck – its is the inability to lift that is the disabling condition regardless of which medical condition gave rise to it.

3. Lastly the R&L must keep you from doing some vital part of your job.

So it goes: medical condition -> behavioral restriction (R&L) -> can’t meed job requirement -> disabled.

Don’t such into medical debates, they don’t matter much as long as your treating physician can back them up. You have to win on being restricted (and or limited) because of the medical condition such that you cannot perform your work. The Disability company will attack you every step of the way. But if you have the facts on your side, and the willingness to pursue your case, if you have an excellent chance of winning.

Tony:

Nancy,

Please listen to the advice given here. I’m in the same situation after 3 years. I was told basically to stop seeing MD shrink for depression. I actually still see a counselor once a month. But, the last set of Daily Activities forms the insurance companies send us generally every 6 months. I did not put the counselor down any longer. I also filled the counselor in on how I see the 2 year mental-nervous claus. I take it serious as in they can change a claim over to mental from physcial. Most of even my own doctors argue with me how they think this can’t happen. They say pain #1 & mental(depression-aniexty-panic)is #2. But, the LTD policy reads like this. If after 2 years your reason in not being able to work any job, if its in whole or “part” related to a mental or nervous condition. We don’t pay any longer. The key wording here is if its even in “Part”. Which it is in part if its stressed?

So, in my case I’m a year beyond the 2 year mark. I stopped the depression meds at the 2 year mark. I stopped seeing the MD shrink whom wrote for those type depression meds. I didn’t feel either that they were helping me any. But I still see the counselor. She is aware & says I’m seeing her for coping with pain now more so. It has been difficult to even convince her that the insurance carrier could be immoral & say that all the spine pain, sleep apnea, etc is all because of depression & stop payments. But, I’ve read stories where someone with a handful of real phycial issues that cause pain. The insurance company still can steer things to the mental-nervous claus which is a terrible thing to do. I believe that “can” happen because things are all governed under ERISA law in federal court versus state court. If things went before a Judge. All he’s going to do is ask 1 question. He will say Nancy was your reason after 2 years in being unable to work in part related to your depression? You will say yes your honor, BUT I have pain first that causes my depression. Then he will say I understand that. BUT, was it in part I asked you? You again say YES. He then reads you the legal fineprint contained in your LTD policy. He says Ms Nancy if after 2 years the reason you can’t work is in whole or part the reason for having depression, then we the insurance company don’t pay any longer. Then that’s it. All your friends, family, opinions, all your doctors can disagree all day long that no they can’t do this because PAIN is your #1 issue. Well, they can & at times they will do it. I have one doctor that has on that last page of my visit notes. That I have depression that is controled, maybe that helps, it mentions aniexty =anic attacks also. I really have tryed to get that so the doctor doesn’t keep duplicating those statements. But, he acts like I’m making a big deal out of nothing. If they stop paying then what’s he going to say, he’s sorry? That doesn’t pay the bills. So, its an issue for sure. When I saw this posting it really hits home & is a very good point to make to others about how the 2 year mental-nervous claus can hurt someone if the insurance company uses it to stop payments.

I wish you less pain & that you really have learned from what’s been said here. God Bless you & be well.

Attorney Greg Dell:

Nancy,

It sounds like you may have a private disability insurance policy. Most disability companies try to limit a disabling condition to mental, so that they only need to pay for 24 months. You need to prepare and anticipate this defense. Please contact us privately and we can discuss how we may be able to assist you with your situation.

Attorney Greg Dell:

Omar,

If you are seeking SSDI benefits, you can usually only receive one year of back benefits. Since you are working full time since October 2012, it does not appear you would be eligible for an earlier period of time. It is great that you have been able to work. Now that you are working you have probably been paying into SSDI, which will likely increase the amount you may be eligible for if you need to file for SSDI benefits in the future.

Attorney Greg Dell:

RJD:

Thank you for excellent and very helpful comment. Your comment is very accurate and goes along with the saying that “diagnosis does not equal disability”. It is the restrictions and limitations that manifest themselves as a result of the disabling condition which are the key in any disability claim.

John:

Mr. Dell this is a great site. Well designed and informative. Thank you for allowing me it’s use.

I have a related question to overpayments captured by insurance carriers once, as in my situation, a railroad worker has been awarded a permanent disability annuity from Railroad Retirement. The insurance carrier had me return the overpayment capturing both tier 1 and tier 2 distribution of my Railroad disability annuity. I believe that is not correct and have challenged the insurance carrier with a letter requesting the monies be returned and that they increase my monthly benefit accordingly. The tier 2 of my annuity is considered a private pension and is taxed as a private pension. I was a co contributor to this pension. With that, I believe the insurance carrier should not be deducting the tier two amount. Do you concur?

Nancy:

Mr. Dell, I will get in touch with you privately. I live in California, will that be a problem?

Attorney Stephen Jessup:

Tony,

Thank you for sharing your perspective.

Richard Croatt:

Sir,

I am a quadriplegic disabled at work in Minnesota in 1978. As a result, I have been receiving worker’s compensation benefits since that time. Recently, the insurance company has stated they have been miscalculating the amount owed to me.

They only learned of the overpayment because of an audit by General Reinsurance Company who now pays my benefits because my insurer (State Farm) has long ago exceeded their dollar cap. (They had an umbrella policy with General Reinsurance.)

After General Reinsurance Co. audited their handling of my benefits and collected $15,000 from State Farm, State Farm then began garnishing $500 per month from their check to me.

My question is: Is there a statute of limitations which would prevent them from recouping over payments made to me because of an accounting error on their part? The errors in payment date back to the early 1980′s on up to recently.

Thank you,
Richard Croatt

Attorney Stephen Jessup:

John,

Without seeing the policy we would not be able to tell. That being said, many policies indicate that 401(k) or other similarly categorized retirement plans funded by the employee are not subject to being offset as “Other Income Benefits.” As such, based on your indication as to your tier 2 distribution from the Railroad, you may be correct in your analysis. Please let us know what the carrier determines.

Attorney Stephen Jessup:

Richard,

Unfortunately, we handle claims for benefits under private or employer provided disability insurance benefits. As such, I would not be able to give you any direction. You will need to consult with a worker’s compensation attorney to determine your legal rights.

Attorney Stephen Jessup:

Nancy,

We represent claimants nationwide. Please feel free to contact us at your convenience. Attorney Cesar Gavidia handles the California cases in our office.

PD in FL:

I was granted LTD through Unum in 2005. In January of 2014 my SSDI was approved. Unum wants over
$43,000.00, I read the post from Helpless in PA, the difference in our case is that my SSDI payment is over $200.00 more a month than what Unum was paying me. Do I really owe Unum this money? They have reduced my payment to $10.50 a month.

What will they do if I refuse to reimbrse them? I have had to pay for all my own medical bills for over 6 years. Is there an attorney in Florida that is willing to take on Unum?

Attorney Stephen Jessup:

PD,

Unfortunately, as is the case with almost every ERISA governed group disability policy, Unum does have the right to seek repayment of the overpayment. Due to the offset language contained in the policy, disability insurance benefits are akin to the carrier advancing you money on your SSDI claim. This is why some carriers give you the option from the start of having your monthly benefit reduced by the amount you would receive from SSDI so there would be no issue (or at least a minimal one) of an overpayment if and when SSDI is received. You might have legal grounds to challenge the overpayment, but from a practical standpoint the cost of litigating those issues often makes it financially unrealistic for an insured to pursue.

Nancy:

RJD, thank you so much for this great information! Wish we could communicate more on this subject.

Minnesotan:

At the end of 2012, my company had decided to change the way they covered their employees during a leave, in my case my soon maternity leave, and went with Lincoln Financial. I was informed I had to purchase it, even though I could be denied by Lincoln (I was 8 months pregnant and had obviously been treated) however I was reassured I would be fully paid during my time off. I received an acceptance letter from Lincoln, another letter saying I was in review a day later, and the day after that I received my first check from them. I brought this up to my employer, and they basically told me it was fine. Total, I received 2,217 during the time I was on my 12 week leave from about Feb 1st – April 2013. Now, Feb 2014, I received a very disturbing call saying I was over paid during my leave, and they need to be paid in full by March 11th 2014. Over a year later! I contacted my employer immediately, and “so they say” they never knew I was receiving checks from Lincoln, and so my employer “picked up the slack” and paid me in full. I understand that I was paid twice, however there was no communication of me being denied, and no communication from my employer. This is even more upsetting because I just cancelled my policy in Jan 2014, and quit my job. Is there some sort of expiration date on when they can ask for these funds?

Rob:

Greg,

I keep reading that you are stating that LTD insurance companies like Unum will take the whole SSDI retroactive payment. This is not entirely true. I have my policy in front of me and it reads:

“Unum will not recover more money than the amount we paid you.”

So I actually was underpaid by Unum so they are not allow to take more than what they paid me, legally. Its written in their LTD Policy on page 6.

I don’t have a problem paying them what they paid me because I think of it as an interest free loan for 17 months. You can’t beat that so all these people should have read their policies when they signed up. Its a business and LTD is different and NO I don’t believe it should be this way because of the premiums should be deducted from any overpayment in my opinion. People has paid 10+ years of premiums and so the interest plus some extra was paid. What I do like about Unum is my life insurance is waived for life and so at least I still have that. I can’t complain because its worth $200,000. Who can beat this in all reality. Some folks are just money hungry. Myself I made sure I paid most of be debts off before I had to stop working.

Attorney Stephen Jessup:

Minnesotan,

Unfortunately, if you were aware you were being double paid by the employer and the insurance company and did not advise the insurance company (as they are the ones claiming an overpayment) they would have the right to seek a repayment of the benefits they paid.

Attorney Stephen Jessup:

Rob,

Thank you for posting. You are correct, they are only entitled to seek repayment for the funds actually paid (less attorney fee for SSDI, if any). In most cases though, that does in fact turn out to be the entire retroactive amount.

Janet Henry:

I had been teaching for about eighteen years, when I began having trouble walking, due to a partial knee replacement, in the year 2009. I have serious osteoarthritis, which was probably inherited from my grandmother. When I was forty- seven years old I saw a doctor, for this problem. My knees would go out on me all the time. It was painful to walk, I would fall quite frequently, due to my knees going out on me and sometimes my knee would go out a week or more, to where I could not walk at all. This doctor did a laproscope, because he thought that there was not way I needed a knee replacement, at my age.

I had seen a specialist, before this particular doctor, who said I had the classic textbook example of osteoarthritis, but he was not going to operate on me, until about five years down the line, due to my age and weight. Well, once the laproscopic surgery was done, by the second doctor, he told me that I had the knees of an eighty-seven year old women.

He agreed to do a partial knee replacement, because he said the outside of my knee was still good. Well, when I began having problems with my knees going out on me, in the year of 2010, my only option was to return to the physician that completed the surgery. He told me that it was probably just bone spurs, under my knee cap and that I would not need a full knee replacement until about two years later. When he went in to shave down the bone spurs, which I did have, in May of 2009, something moved in my knee. So he opened my original incision from 2009, and found out that a piece on the prosthetic was extremely bent and about to fall off. So, he went ahead and did a revision surgery, replacing the piece with another, larger part. He was not even specialized in revision surgeries, but he completed it anyway, sending me home as an out patient. I saw this doctor from June of 2012, until the very beginning of Jan. 2013. He refused to give the school board a letter stating that I could receive a one-year leave to recuperate. He kept saying that I was too, fat and that I needed to lose weight. Every explanation that I would give him, concerning my condition, he made me feel like I was stupid. I told him that I did not think I could stay on my feet, if I went back to work. I begged him to put a full knee prosthetic in my right knee, so that I could recuperate and return to work, but he refused. so, in my last visit, Jan. of 2013, I asked him to release me because he was not doing anything to help me. I also told him to refer me to another doctor, that I had heard many good things about, concerning his specialty, as a orthopedic.

I went to see the other doctor, that I had asked for a referral to, at the beginning of Feb. of 2014. He was so upset, right when he walked in the room. He said that the other doctor should not have done a partial knee replacement on me, because I was not even a candidate for it. He sent me for a number of test, mostly to see if I had a bacterial infection. Because one of my complaints was extreme pain, especially at night, from my knee, down to my ankle. He even asked me to go get the laproscopic pictures that the previous doctor had shown me, but they would not release my records to me. The lady in the office said that they could not even make copies for me because they would not be clear enough to see. So, I went to the hospital, that he completed the laproscopic surgery at and got a copy that was left on the computer.

I showed the orthopedic specialist and he automatically could see, in one of the pictures that they was something sticking out. And another complaint of mine was that sometimes, it literally felt that my knee was cracking all around. The doctor agreed to do surgery on March the 20th, of 2014.

When he came out of a very long drawn out surgery, he told my husband that when he opened me up, he did not know what to do, for a split second. He said that my partial was not even attached to my thigh bone and it had subsided down to the tibia part of my leg, creating a hollow hole. so, he removed the partial, fixed the hole by running a metal bar under my knee, then put a full knee replacement. He told my husband that he didn’t know how I could stand the pain.

So, long story, short. I collected 2600.00 dollars a month from my group policy from June of 2012, until Jan of 2014. The LTD is through Standard. They sent me a letter saying that I was no longer considered to be disabled. And, even though my doctor had not released me yet and my twenty-four month period was not over, I could go back to work because teaching is considered a light duty job. But, they also said on the letter, in their definition for disability, that I had to have a physical disease, injury, etc. to be considered disabled. Well, I have osteoarthritis, which is considered to be a physical disease and possibly osteoporosis. My family doctor and my orthopedic made me do a bone scan, a week ago, so I am waiting for the results. Well, that is a physical disease, as well.

I went to my employer and they told me that they just sold the insurance, they didn’t make the decisions, but without a doctors release, I would not be able to go back to work and that teaching is not considered a light duty job and they do not take any one back on light duty.
My doctor is aware of that, as well, but he is not releasing me because the main muscles in that one leg were cut on three times. And since they are main muscles that hold the skeletal system, they have to heal, so that they can become elastic again. They are so limber, I have to watch the way I walk, because my knee moves forward alot, because the muscles are not holding the skeletal bones of the leg, as tight as they should. He said that it was not just a full knee replacement and that it would take longer to recuperate. My muscles sometimes get caught in my knee cap, which causes me not to be-able to walk on that leg. So, I am still in pain and on pain meds., which would limit me from being able to teach the extremely hard science classes I teach, to seniors in high school that are mostly college bound.

So, my question is, why have they closed my claim, if my two-year mark has not been reached and my orthopedic physician has not released me yet.

I wrote a letter of appeal, addressing to them, why I could not work in my own occupation, at this point in time and justified it. What can I do? I have no other income!

Attorney Stephen Jessup:

Janet,

Disability insurance benefits are unfortunately never a guaranteed benefit. Most likely Standard states in its letter that some doctor, whether an employee of Standard or an outside independent doctor, reviewed your medical records and determined that you would be able to work in your occupation with certain restrictions, which Standard assuredly determined would be light duty. Based on this and despite your doctor’s opinion, Standard had enough “ammunition” to deny the benefit. As to whether the denial will hold is another matter. As you have already filed your appeal all you can do with respect to the benefit is wait for Standard to issue its response.

Antonio:

Is there a SOL for recovery of overpayments? This was a good question I don’t think was answered. What state law would apply – yours, your employer’s, or the company’s? Or Federal?

Attorney Stephen Jessup:

Antonio,

If the policy is governed by ERISA, then all state laws would be pre-empted in favor of federal law. As a statute, ERISA does not indicate a statute of limitation. In turn, if the policy indicates a statute of limitations (many indicate three years) then the courts will apply same; and in the absence of any indication in the policy the courts will revert to the applicable governing state law statute of limitations.

Antonio:

So, the time in which they can try to recoup amounts already paid (i.e. function as debt collectors) is addressed or limited by policy? Which state law SOL would apply? The one for debt collection? Or contract action?

Susan:

My LTD insurance company paid me $2009.00 a month from Jan 2013 through Feb 2014. I became elig for SSDI as of 3-1-14 and received a letter from SSDI stating my benefits due for the Jan 2013 – Feb 2014 period was $18568.00 They paid $4306.50 to the agency that represented me and sent me the balance of $14261.50. The agency sent me a letter FIVE DAYS LATER to state that I should put the overpayment aside. I didn’t realize I had to put the money aside until this time so I spent some of it to pay long overdue bills. Will LTD companies accept payment plans as there is no way I can come up with $14,261.50 in a lump sum. Or am I obligated to borrow money to pay them back. I am widowed and I have no savings accept the $10,000 left from the overpayment. Will the LTD insurance pay me the difference of $751.00?
Thank you.

Attorney Stephen Jessup:

Susan,

Most carriers will work out some type of re-payment plan. Typically they will withhold all benefits due to you under the policy (in this case the $751) until the repayment is satisfied. However, you will need to contact them to discuss what your repayment options are.

Nichole:

Hi,

Is there a statue of limitations on how far back a LTD carrier can ask for an overpayment? I live in Florida.

My LTD stopped in Sept 2011, I had a 24 month disability policy and when the 24 months ended, I was no longer receiving LTD.

I did apply for SSDI and was approved in May 2011.

I heard from the LTD once in a letter asking for approximately $20,000 (this was in 2011 October). Heard nothing since.

I have looked on my credit report nothing there

I filed for bankruptcy (13) IN June of 2010. I was on LTD but had not heard from SSDI at time of the BK filing.

I am concerned about this and cannot find information relating to this type of situation.

Thanks.

Attorney Stephen Jessup:

Nichole,

I doubt you will necessarily find information directly on point with the facts of your case. Any statute of limitations applicable to your policy will mostly likely be contained in the policy itself. Typically, in ERISA policies it is three years. However, that is not to say that there might be something about your case that extends that period. If you have not heard from your carrier since 2011, it might be possible you might not again.

Jean:

Can the Hartford Insurance company offset SSD and Disabled Survivors Widows benefits from their LTD payments? Just wondering if Disabled Survivors Widows benefits are exempt.

Terry:

Once again I thank you for your time and valuable information, where else would we go for what you give us without having to spend big dollars on retaining a lawyer. Greatly appreciated. The Principle (LTD) owes me $560 a month, after reducing me the $1560 that SSD is paying me, that they are now keeping toward their repayment of the overpayment. I still have 41 months of eligibility left from Principle and they will be repayed fully after 35 months and they agree to this which on the surface works and is fair. My question has to do with what I see as a major potential problem. In September of this year they are saying that they will make a determination on wheather or not they can force me into some sort of job due to an any or all type of clause in my contract. The first two years of my contract kept me totally disabled because wording in our contract protected me as long as I couldn’t return 100% to the job I left but that after that two year period they could force me to take any job available or reduce my claim to a percentage of it’s original amount or completely. If they do this and I refuse then they will come after, thru courts, the monies that I owe them since the monthly payment back to them would now be reduced or withdrawn completely and I would have no way to pay them back as my income is now $1560 instead of $1560 + $560 from principle before the ssd award. I am afraid that they will use this any/all clause as a loop hole in getting out of their monthly commitment to me. My ace in the whole has been my potential retirement from the company I was working for at the time of my disability which if I took now would make up for the $560 a month I’m loosing as payback to Principle. The company I worked for was Hostess who is now out of business and the retirement monies would come thru the union. Is there any way that Principle will find out that I have done this (retired) if I don’t tell them, especially since Hostess (IBC) is now defunct. And, how do I battle this any / all clause that if forcing me to take some meniall job could negate my SSD as they deem me totally disabled. Terry.

Dana:

I have a complicated question. However, I feel as if I must explain it all. In April of 2012 I was pulled out of work because of my brittle diabetes and some continuing ligament problems. I filed my short term disability that day and they denied me. While walking on crutches, it caused some issues to reappear in my neck and shoulders and my nerve problem came back in my hands. So, I was told by yet another dr. not to go back to work yet Prudential denied me. I had surgery in July due to the fact I had to have several doctors clear me for surgery. They back paid my ST to June when my orthopedic surgeon wrote them a letter stating I could NOT work. While my general was fighting for the other reasons. Prudential was clear that they would not pay the short term on the general practioner’s word. So, when it came to being off for longer then what PRUDENTIAL said was a good time for healing I had to fight AGAIN to get the short term… that I paid for! Because of the diabetes had a longer time of healing and had to literally make a complaint with the state insurance protection cabinet(or something close to that name). I recieved a letter a month later stating that I would be getting long term but was subject to it ending soon. While off lost my job for being off to long, went into full multi system auto dysfunction. Lost insurance and really didn’t have a way to keep up the cobra. I missed a doc appt that Jan. they canceled me. When I appealed they told me that they could NOT give me answer to the appeal until I signed a paper with ALSUP. Their legal team I suppose. Now, SSDI is holding my backpay on grounds of workmen’s comp. Now, my question is. How is LTD workmen’s comp. Workmen’s comp to my knowledge is thru state and businesses paying for an individual. I did NOT receive workmen’s comp. How would this insurance be any different than that of car insurance? They don’t hold back for that!

Attorney Stephen Jessup:

Jean,

Typically only Social Security benefits received on account of your disability (SSDI or DSSDI) is considered Other Income susceptible to offset under the policy. In an abundance of caution I would refer you to your policy.

Attorney Stephen Jessup:

Dana,

LTD is not worker’s compensation. Allsup is the company hired by Prudential to secure your SSDI benefit. As your problem appears to be with having the funds of your SSDI released, you will need to contact Allsup to get a clear answer.

Attorney Stephen Jessup:

Terry,

The insurance company will always seek any repayment regardless of whether you decided to appeal the decision or not. I would caution you not to dip into your retirement account as most disability policies consider retirement benefits a source of “Other Income” susceptible to offset under your policy. Until the carrier makes its decision as to your ongoing entitlement to benefits under the any occupation definition of disability much remains unknown and conjecture.

Bob:

Hi,

I was approved for SSDI in January and now owe Standard Insurance as I expected. My back pay was larger than the total LTD payments, so I will have to pay back all of the LTD minus the attorney fee. I also found out that I have a minimum benefit of $100 per month. My question is, do I have to pay back my minimum payment I received in the past or can I subtract also?

Attorney Stephen Jessup:

Bob,

No, the minimum benefit is the benefit Standard must pay regardless of any reductions for sources of other income.

Mitch Chuich:

Hello. I have an own occupation plan with prudential under which I receive COLA adjustments. I have been on the plan for twenty years and received COLA the entire time. In a review of plan late last year they told me my plan only guarantees COLA for 5 years (I checked the policy and they are technically correct) and they are recalculating my benefit. Will they be allowed to retroactively take back 15 years of COLA. What a blow this would be. Interestingly in 2009, 16 years after going on disability, they sent me check for COLA adjustments they forgot to make for 3 years.. The letter used the language, “which you are entitled to.” Do I stand a chance of not being hit with past COLA liabilities? Thanks much.

Attorney Stephen Jessup:

Mitch,

There does stand a chance that Prudential might not force you to repay any of the benefits paid based on their mistaken calculations. In the event that they do try to assert an overpayment repayment please feel free to contact our office to discuss how we may be able to assist you.

James:

This is short and to the point. Can my insurance ask that 500 as over payment? I mean the 500.00 dollars I get for medical help is the government assistance. I have a sinking feeling about this.

Thomas Collura:

My daughter receives SSDI payments from my claim and her mothers claim. My daughters mother and I are were never married and do not live together and I have full sole custody of my daughter. The offset is for the combined amount my daughter receives. Can they offset this total? If the offset for my daughters SSDI payment from her mothers claim is an error, can I recover this money from Liberty Mutual?

Attorney Stephen Jessup:

James,

You will need to review the terms of your policy and what constitutes “Other Income” subject to offset under the policy.

Attorney Stephen Jessup:

Thomas,

That is a very unique fact pattern. Typically the policy language typically only allows them to offset your benefit based upon Dependent SSDI benefits that are attributable to your disability. I would recommend seeking written clarification from Liberty Mutual as to how they came to any conclusion in contrast to that.

Antonio:

I was awarded SSDI after starting LTD, and my LTD policy has an offset provision. Before starting my benefits, SSDI withheld $5000 for a previous overpayment that occurred 2 years before I was on LTD benefits. Will the LTD make me pay them $5000 because of this, even though I never actually received the money?

Attorney Stephen Jessup:

Antonio,

Unfortunately, I don’t have an answer as to that scenario- as I have never encountered such a situation. Have you contacted the carrier to advise of the SSDI award? If so, have they contacted you with respect to the overpayment repayment due?

Patti Schrimscher:

Attorney Stephen Jessup:

I have been receiving Long Term Disability from Reliance Insurance in the amount of 1006.50 for almost 2 yrs. I have a in person hearing with me, lawyer and a Judge present. I am now hearing of the repayment that will probably take my whole amount of back pay. I have been waiting for this back pay to pay off bills I have accrued since being disabled. My benefit check was not enough to cover my bills so I resorted to using credit cards to maintain the things I needed and my daughter that has a year old son and one on the way. I have no other income. I was hoping to pay these cards off and cutting them up when I finished using them. What if I do and then they come after me for the repayment? I heard from my advocate that I might could make payments to them. Is this possible? If not, I see no other choice but to go bankrupt. I reside in Kansas but everyone I speak with from Matrix, my advocator and Reliance Insurance are all located up North. I don’t know how to deal with it and I’m very uneducated about it as well. What happens if I do take the money and pay off my medical bills and credit cards? I had a spend down of over $3000 every 6 months so I had to pay for all meds and office visits and procedures. This is where the credit cards came from. One of my co pay for my 8 different meds is almost $200 each month! I need surgery but I can’t afford it and I was going to use part of the back pay for going towards that. I don’t know what to do.

Attorney Stephen Jessup:

Patti,

Unfortunately, I cannot advise you what to do- that decision is ultimately your and yours alone. However, you will ultimately owe the money back to Reliance Standard.

Jeff:

Hello

I have been receiving long term disability payments from NW Mutual for the past 5 years for an own occupation policy. I receive a monthly benefit of 1500 plus another 1900 from a SIS rider I had on the policy. I was denied SSID in 2009. I reapplied for SSID per NW Mutual’s demand. I was approved just for SSID a just received a lump sum of 21000 (16 months) from SSID. I understand that “I reimburse the company for those increases that would not have been paid under the SIS benefit.

The policy also states that between the beginning date and the end of the SIS benefit Maximum benefit period, the full benefit will be increased by:

a. 100 % of the amount of the SIS benefit when the insured is not entitled to Social Security disability benefits; or

b. 40% of the amount of the SIS Benefit when the insured, but no member of the Insured’s family, is entitled to Social Security benefits based on the insured disability.

I will continue to receive the basic own occupation policy amount of 1500, and now SSID from the government 1500 per month, but my question, will I receive 40% of the $1900 from NW Mutual in the amount of $740, under policy (b.) since NW Mutual’s payment was greater than what I am receiving from the government.

Thank you,
Jeff

Attorney Stephen Jessup:

Jeff,

We would need to see your policy and any applicable rider in order to potentially assist you.

Long:

My husband was on LTD with MetLife for the last two years and was receiving a monthly amount. He applied for Social Security Disability back in 2011 but was denied. As of now 2014, he was approved for SSD benefits and has received a back payment from the first time he applied in Oct. 2011 until the current date for the amount that SSD will pay him each month.

In the itemized list on the ‘Payment Summary’, it does show ‘Here is how we figured your first payment’ but it only goes back to April 2012 until April 2014. I am not sure if we are going to receive another lump payment for Oct. 2011 through April 2012. He will have to call and ask. However, in the Payment Summary, it shows that $3500 was paid to his representative, which MetLife assigned him.

According to a representative from MetLife, they are stating that we have to give all that money that we received for back pay from SSD to them or they can sue. We contacted a lawyer here in Texas and they stated that if MetLife was not listed on the Payment Summary for owing payment or amount owed to MetLife, then we do not have to pay them back the money. Is that true?

The SSA knew that he was being paid LTD from MetLife but did not state that they were owed repayment, only that they took out what was owed to the representative that helped him with his case, which again was provided by MetLife.

We are not sure what to do at this point. Are we required to pay them back? The amount that he will be receiving each month from SSD is less than what MetLife is paying him. From our understanding, if we keep the money and don’t pay it back, then MetLife will not pay the difference each month to make up for the amount he is receiving now, however, if we pay the money, then they will continue to pay the difference each month.

Attorney Stephen Jessup:

Long,

Under the MetLife policy, they will be due an overpayment on the back benefit check. However, they cannot make you repay the $3500 that the SSA determined the lawyer was entitled to.

Antonio:

I have a good one for you.

I was on LTD and I was told by employer that I need to return to work by May 6 or face termination. I asked for accommodations and tried to return to work. When I did, they fired me.

So can I go back on LTD? The doctor will agree because he wasn’t ready to release me anyway, but I persisted so he agreed with restrictions. I have an “own occupation” policy so it is clear that I cannot work in my own occupation (lol). But the “sole reason” must be disability. I am clearly disabled enough for that, but it would seem that illegal discrimination and refusal to accommodate would be other reasons.

Neal:

Hi,

I was approved by UNUM for STD on March 24, 2014, and allowed benefits starting March 31, 2014 (7 day waiting period per my employer). On April 10th, while on STD I was terminated by my employer for not being eligible for FMLA due to length of employment…

My question is:

1. STD and LTD is through employer – does this benefit stop (they told me it ceases after termination) even though I was approved for STD (Unum) before termination.

2. Isn’t termination illegal if I am offered protection from the ADA – being that a documented disability that I had prior to being employed, but was only worsened from the conditions of that employment – enough that I had to stop working. A mention of an accommodation was discussed, but only fleeting and not accommodation was made prior to termination.

3. What are my legal alternatives… The employer is a VERY, maybe the best known cancer hospital in the world, and I have had a very good work record and employed my whole life. I am in a protected class, a 50 female, and am no unable to work. Something seems very wrong about all this.

PainFueled:

There’s something about this that I’m not catching… if SSDI is retro-paying me 15 months and my carrier is requiring reimbursement for those 15 months, wouldn’t I just take the funds I receive from SSDI and give them to my carrier? I interpreted the repayment policy to be an anti-double dipping clause… I’m not trying to go to Paris here, I’d just like to keep the heat on and occasionally wallow with my pals Ben and Jerry.

After 8 months of proving my work worthlessness, my claim was finally approved and I received my retroactive payment via check. My bank account is currently negative, but I haven’t deposited the funds because I fear it’s “to good to be true” after the hell they’ve put me through. If this SSDI situation is the catch, I’d greatly appreciate a heavy duty mitt!

Attorney Stephen Jessup:

Antonio,

It would depend on whether your policy has a “recurrent disability” provision that would allow you to re-open your prior claim. Please feel free to contact our office to discuss how we may be able to assist you.

Attorney Stephen Jessup:

Neal,

If you were on disability at the time your employment was terminated then you would still be covered and have rights under your respective disability policies. With respect to your questions regarding employment, you will need to consult with an employment/ADA attorney to see if any of your rights were violated.

Attorney Stephen Jessup:

PainFueled,

For all intents and purposes, yes, you would be basically handing the entire back benefit check over to the carrier based on your hypothetical.

Bob:

Once I was approved by SSDI, Standard Insurance C.. requested that I go to a provider to get an independent evaluation. I complied, but the doctors office refuse now to give me a copy of my medical records for the evaluation and they tell me I must get them from my LTD, Standard. Standard Insurance will not reply to my request. Am I entitled to my records and does the doctors office have to comply with my request?

Attorney Stephen Jessup:

Bob,

The IME doctor will not release the records from his exam? I would suggest you make a written request to Standard for a copy of the IME report, or in the alternative that they provide it to your treating physician. I do not know if the IME doctor has any duty to provide you with the report.

Darren:

My question is this. My employer has a 365 day grace period before you can receive LTD so during this time I received STD. I have been approved for LTD and been informed that I must now file for SSDI, but I have already filed through an attorney 12 months ago. When I receive my back payments from SSDI will MetLife be entitled to the 12 months of back pay prior to being awarded LTD?

Also I wanted to thank you for your posts… they contained a lot of answers for some other questions I was going to ask. One that I was wanting clarification on was, MetLife does not have a box to check as income on the questionnaire for VA benefits but they do have the all other box. My disability payments from my combat injuries are over 20 years old and predate anything to due with my employer or MetLife. Can they recover these funds in their overpayment policy? I read it a few times and nowhere does it specifically say they can… also I was informed by the VA that no-one but them can garnish these wages.

Attorney Stephen Jessup:

Darren,

Thank you for your feedback, and know that we are glad to be able to assist. The LTD plan might not be entitled to any repayment of benefits from the SSDI, but the carrier/payor for the STD benefits most likely will if SSDI was an offset under the terms and conditions of the policy. As for your VA benefits, the vast majority of policies do not allow for the offset of VA benefits.

Jon Burrows:

I filed a worker’s compensation claim with my employer a year ago for an injury that was caused by repetitive motion. I hired an attorney as the claim was denied. During my time off of work I was paid through a private disability insurance carrier that my employer uses called The Standard. For the first few months I was paid via Short Term Disability Benefits and then that converted over to Long Term Disability Benefits. I appealed to the Worker’s Compensation Appeals Board and finally after 10 months I reached a settlement with my employer through a Compromise and Release Agreement that was approved by the Worker’s Compensation Judge and stated that I will be payed a lump sum “NEW MONEY” settlement. This settlement is in addition to any money or benefits that I have already received. As a condition of the agreement I agreed to resign my employment with my employer. I contacted The Standard Insurance to notify them that I am no longer employed with my employer through whom I have their insurance with and that I no longer need the LTD as I have settled. The Standard informed me that they need all the information regarding my settlement as they believe they are entitled to repayment of the benefits they have provided me with. I informed them that I have not yet received the lump sum settlement payment and that I wish to close my LTD claim and that the settlement award is not for lost wages. They informed me that they believe they are still entitled to repayment and that I will need to payback what they claim is overpayments immediately within 30 days. Is this true? How can they be entitled to a settlement award that is “NEW MONEY” for my injury. As per the Compromise and Release Agreement it states that $0 will be deducted for Short Term Disability. Can someone please explain or help me with this?

Chuck:

Another “MetLife” scam victim, my company paid for my STD, I and I alone paid for my LTD. Can Met go after back payment SSDI druing the STD 26 weeks? Along with any money after LTD starts?

Can I just not use my LTD and keep my SSDI money?

Can Met go after other ins. policys that pay me money from my accident that I pay for?

Attorney Stephen Jessup:

Jon,

Depending on the policy language they could be entitled to a repayment of benefits forwarded. You will need to secure a copy of your policy in order to determine same. Additionally, it sounds like you are still eligible for LTD benefits under the Standard policy. If you are not returning to work you might want to consider keeping your LTD claim open.

Attorney Stephen Jessup:

Chuck,

MetLife can move to recover any overpayment of SSDI benefits under the LTD policy as well as for your company under the STD policy. Even if you were to close your current LTD claim they would still be entitled to collect any overpayment.

Patti Schrimscher:

If you have to return the overpayment to the disability insurance company, then what about the bills you accumulated waiting on SSD? I have large credit cards bills due to high cost of medications. I am on a spend down of over $3000 every 6 months. One of my meds is almost $300 by itself. I used credit cards for Dr. bills and all other medical bills that I was responsible for. I was planning on paying them off when I got my back pay but now it looks like I don’t have a back pay at all. The total credit card debt is over $10,000. I will have to go bankrupt just to be able to make it. I was on STD first and then went on to LTD. It’s been over 2 years now. I don’t know what to do now.

Attorney Stephen Jessup:

Patti,

Unfortunately, you’ve found yourself in a situation that many people relying on disability insurance benefits face. There is very little that can be done to erase an obligation for repayment of benefits on account of a SSDI overpayment. You could attempt to negotiate a repayment plan with your disability carrier.

Chase:

I’ll try and keep this short, feel free to ask any questions necessary.

I was making $60k a year as a satellite technician, I had wonderful benefits, one of which was Long-Term Disability Insurance. I became disabled in early 2008 with bulging and degenerative disks with debilitating pain and a frontal and bi-temporal lobe closed head injury that severely limits my memory. I went through many battles at the time including with SSDI. The massive decrease in income has massively affected me and my children’s lives. While sitting with a friend they made a statement that “too bad I didn’t have long-term disability benefits at the time because I wouldn’t be having such a hard time now, it jogged my memory and now I’m trying to figure out if it’s possible to file a claim so long after the fact. I’m sure people who’ve become disabled understand the obstacles one faces and having a closed head injury didn’t make anything any easier, I fought to survive and keep me and my children going strong and definitely dropped the ball on the insurance. If anyone knows if it’s possible and knows an attorney willing to handle such a case please let me know.

Attorney Stephen Jessup:

Chase,

It certainly does not hurt to file a claim with the carrier, but there stands a likely chance that your claim could be denied for failure to provide Notice of Claim and Proof of Loss within the mandated timelines in the policy (typically 90 days after such loss).

Steve Gunn:

My private ins. co. (Group Policy) is trying to recover $33,000 of SSA Retirement benefits that I began at age 62. They sent me a Reimbursement Agreement that I signed and returned in a timely manner I 2000, which included “offsets” language for SSA Disability only. Any thoughts on their entitlement?

Attorney Stephen Jessup:

Steve,

You will need to review the policy. Typically, ERISA governed disability policies do list Social Security Retirement as a source of other income benefits. If your policy indicates same, then the carrier would be entitled to seek repayment.

Andi:

I have a 2 year own-occ LTD policy with Lincoln. I’ve been working with them for months and a determination has yet to be made. They paid 4 weeks of STD. I’ve filed for weeks 5 through 13 at which point the LTD takes over.

If I am approved for SSDI (in July), will the likelihood that Lincoln will recognize my eligibility for LTD?

Attorney Stephen Jessup:

Andi,

The receipt of SSDI would definitely be strong evidence of disability from a medical standpoint that Lincoln will take into consideration. Additionally, from a more practical financial standpoint, as Lincoln will offset the amount they will owe you monthly by the amount you receive from SSDI you will be less of a financial burden to them, which could also help in getting your claim approved.

Helen:

If I apply for disability and am awarded SSDI, do I offset what I’m receiving for LTD from my SSDI? I’m not sure what to do if I just apply for SSDI and not the LTD?

I’m pushing myself to contiue to work and it is becoming increasingly harder to do so, I’m looking for what Im supposed to do if I have to stop working. I don’t want to get into this I owe SSDI or LTD money back.

Attorney Stephen Jessup:

Helen,

If your policy is governed by ERISA, the chances are it contains language that allows the LTD carrier to offset your benefit by the amount you receive from SSDI. Some carriers give you the option of having the estimated SSDI amount withheld from the monthly LTD check in advance of a SSA ruling. So if you are concerned about large overpayments to your LTD carrier I would suggest you inquire as to same.

BW:

I have a problem with Cigna in that they are requiring my partner to pay back money he has yet to receive from SSDI. He was awarded SSDI and did as Cigna requested of him and segregated the retro payment from SSDI. Cigna took the full back payment every cent that was paid by SSDI. Then proceded to tell him that he owed another $500. This amount was due to the last payment he received from Cigna overlaping the retro payment by SSDI by two weeks. Cigna paid thru May 15th and SSDI only paid until April 30. He has to wait until the third week in June for his May benefits from SSDI but Cigna wants that money now, leaving him $500 short for the month. The thing is no matter when they get the money back they leave him short with the shedule they have him on for payments and the schedule that SSDI pay him. The reps at Cigna that I have spoken with agree it is not right to do this but it is company policy. Is it legal for them to demand money not received from SSDI yet?

Attorney Stephen Jessup:

BW,

This is a typical scenario and is based upon the fact that the SSA pays in arrears. As such the applicable offset of the monthly benefit occurs despite the SSDI payment being received.

Mary Williams:

Mr. Dell,

I began long term disability in January. I had purchased disability insurance through my employer with a well know insurance claim. My benefit was 70% of my salary non-taxed. The insurance company told me I had to file for social security disability and that whatever I didn’t receive from that, they would make up the difference. I did this and was approved and have been receiving both payments each month totally 70% of my pay. My question is was this really a requirement? Did I have to file for social security disability when I already had a policy guaranteeing me 70% of my pay? I understand you have to be disabled for 24 months in order to qualify for medicare. Would this be why you need to begin your social security disability so you are eligible? I’m feeling sort of cheated by the insurance company because if I didn’t have to file, I wouldn’t have to be paying taxes on any of the income I receive which was my benefit. Right now, I will owe taxes on approximately half of the income because the part I receive from the government is taxable. So, this is sort of a two-part question. Did I have to file for social security to receive my benefits from the insurance company? And can you apply for medicare if you’ve been receiving disability from a private insurance company for 2 years?

Attorney Stephen Jessup:

Mary,

If your policy indicates SSDI as a source of Other Income which you have a duty to apply for under the terms and conditions of the policy, then yes, you had a requirement to apply for the benefit.

Jean West:

I was approved for SSDI the same month I applied, March 2014. Cigna, my LTD, had been paying 3 months at the time I received my first SSDI check. There was of course no back pay.

$3250 gross, 2901.33 net 1/16/14 from Cigna
$3250 gross, 3001.37 net 2/19/14 from Cigna
$3250 gross, 3001.37 net 3/19/14 from Cigna
$3250 gross, 3020 net 4/18/14 from Cigna
$1880 gross 4/25/14, from SSDI; sent to Cigna for overpayment
$1370 gross, 1140 net 5/19/14 from Cigna
$1880 gross 5/28/14, from SSDI.

Even though I have not received more than the benefit per my policy of $3250/month, in any month except April, of which I sent them the over-payment, they claim I still owe them $1566.67. They say its because SSDI pays in arrears 1 month and they pay “real time”. So they want reimbursed for March, even though I didn’t get any money from SSDI in that month. Can they ask for money I never received? Isn’t this fraud on their part?

Attorney Stephen Jessup:

Jean,

If your SSDI award contemplated benefits beginning in and including March, then Cigna would be able to assert an overpayment.

Mike:

First off thank you for tho site and your help. I am 56 and I am on short term disability and so to go long term. I am able to do what the company calls level-income retirement. Can the long term insurance company force me to do this?

Terrie:

After reading all these scenarios, can someone please tell me the purpose or benefit of paying for LTD? It seems any money you get from LTD has to be paid back once you get SSDI. So you are actually paying out for disability insurance that if you end up using and then end up on SSDI, you will end up paying back. I am now considering having my husband cancel his LTD insurance.

Attorney Stephen Jessup:

Mike,

A review of your policy would be necessary in order to determine what your carrier could do. Many policies contain provisions that relate to sources of “Other Income” that can reduce your monthly benefit. Under these provisions an insurance company has the right to offset your benefit by sources of Other Income you receive OR are eligible to receive. Retirement is often such a source of Other Income. However, it is not common to see an insurance company enforce the “eligible to receive” provision as it relates to retirement benefits, but it is something to be cognizant of.

Attorney Stephen Jessup:

Terrie,

Before you have your husband cancel his LTD insurance please be aware that the amount he might be eligible to receive from the SSA may not be the same amount he receives under the LTD policy. For example if his monthly disability benefit from the LTD policy is $3000 and SSDI only pays him $1800 a month, the insurance carrier would be on the hook for the other $1200 so that your husband’s benefit would still total $3000 a month. Please note your husband can also explore his options in purchasing individual disability coverage through an insurance agent. Such policies do not contain offset language relating to SSDI benefits. However, the premiums for individual policies are much higher.

Angelina:

I got approved for non work-related disability at work (gov’t agency) just recently after 9 months. I also have LTD payments from my long term disability insurance from work which started 2 years ago while I was still working part time. I also applied for SSDI but it still pending. Anyway, I got a retro payment this end of May from my disability retirement at work, but my insurance wants to take all of it $4,000 plus some more (I have to pay more that I got) because of taxes and other deductions. I signed the paperwork they gave me for SSDI that they will get the retro pay from SS but not from my disability retirement from work. Is this legal for them to do even if I did not sign any paper to pay them back?

Attorney Stephen Jessup:

Angelina,

If your policy lists disability retirement as a source of “Other Income” subject to offsetting your long term disability benefit, then the carrier would have the right under the policy to seek repayment of benefits provided.

Wondering:

My LTD company, Principal Life, is in the process (after 9 years) of reviewing my claim. They just sent me a letter titled “Request for HIPAA Compliant Authorisation” to sign in order to avoid any possible interruption of benefits or delay in claim determination because we can’t obtain your medical information. It states their form complies with the HIPAA Privacy Rule.

The form I am to sign and return is titled: Authorisation for Release of Personal Health and Other Information to Principal Life Insurance.

It states that I authorize anyone that has provided treatment or service to me to disclose my entire medical record. (does not state since I was disabled or for whom I have been treated for disability)

It also authorizes the IRS, social security and past employer to provide info about my employment and income.

Does this seem legitimate?

Attorney Stephen Jessup:

Wondering,

The authorization for release of information you describe contains very common, overly broad authority to allow information to be released. You do have the right to limit the authority granted under the authorization. Please feel free to contact our office to discuss how your claim further.

Lori:

My husband had long term disability, and they paid for about two years, then some doctor at a desk (who had never layed eyes on him) decided he could go back to work in a sedentary position. He is missing two major components of his immune system due to this work related incident, and CAN’T be around anyone who is sick.

They did want over $16,000 when SS started paying, and we sent it to them, then they basically said he could go back to work. We figured we were little people fighting big insurance, and his Workman’s Comp attorney pretty much told us there was nothing we could do. Too late to tackle that now.

My question is this, after 11 years of fighting a Work Comp case in CA, we actually finally had some settlement discussions with the opposing counsel (who recently replaced the one who had been on it), and when we asked our attorney about writing a letter to SS explaining that any monies would have to last my husband the rest of his life (like he told us he would do in 2003), he is now essentially saying ‘screw them (harsher language), I wouldn’t tell them anything’. In CA, do you have to notify SS when your case settles? A MO attorney friend said they have to write that letter by law to Social Security. We don’t want to take his NEW advise and blow them off, then end up having to pay them half of what we may finally get!

Rick:

I was getting LTD from the Hartford for about 24 months. They denied me further payment after that because of their “primary” job versus “any” job wording in their contract. I appealed, but they sent me a letter saying their usual, that I could do sedentary work and my case was closed. Now seven months later I have been awarded SSDI. If they seek over payment can they only claim the over payment for months they actually paid me or can they take the whole check? If they can only seek over payment for the months they paid me, can I deduct the attorney’s fees off the top of that, and lastly since the SSA says I can’t do sedentary work, would the Hartford have to re-open my case and back pay me the benefits I was denied when they said I could work and obviously couldn’t?

Attorney Stephen Jessup:

Lori,

You will need to consult with an attorney specializing in Social Security to determine what duties and obligations you may have reporting any settlement amounts under the SSA rules and guidelines.

Attorney Stephen Jessup:

Rick,

Hartford would only be entitled to a repayment of benefits on account of the SSDI award for a time period that corresponds to when they were paying you. Any amount would be less the attorney fee award allowed by the SSA as applicable to the same time period. Receipt of SSDI benefits is not a guarantee that you will receive benefits under a private disability insurance policy. That being said, it is STRONG evidence of same. Of concern is the fact that you indicate 7 months have passed since the denial of benefits. Under ERISA you have to file an appeal with 180 days from the date of denial. Did you ever file your appeal?

Rick:

Mr. Jessup, I filed a written appeal on my own without the aid of an attorney, probably within two weeks of the denial letter. The issue may have been a letter they sent to my Doctor (one of hundreds), when he answered he replied in a very pin pointed response that only dealt with one of my health issues, not on me as a whole, and as you would expect they hung their hat on that letter refusing to send another letter asking for clarification. Never the less, to be honest they had beaten me down with the constant barrage of forms and phone reviews that I was relieved to be finished with them, or so I thought. I’m to the point now that I’m ready to take the back payment check back to my local social security office and tell them to refigure it and base the back pay back just to months I wasn’t receiving LTD just so The Hartford can’t touch it (i’m sure my attorney wouldn’t appreciate that).

Kevin:

I draw 100 percent VA disability, can I also draw SSDI or is my VA compensation considered earned income?

Attorney Stephen Jessup:

Kevin,

Unfortunately we do not handle VA disability claims so I would not be able to properly answer your question. I would suggest consulting with an attorney that handles VA claims or one that handles SSDI claims.

Sammy:

I was receiving LTD from The Hartford when I retired finally. I had no other income except Hartford. Then after a year My Teacher Retirement of Georgia kicked in monthly. I did not tell Hartford my TRS was paying as I was so ill I couldn’t have. Hartford found out about my TRS and cut it off. SSDI was filed and rejected 3 times during all this. Now Hartford wants $15000 in overpayment. I just got approved for SSDI not have my gotten backpay or monthly benefits yet. Can I file for bankruptcy against Hartford? I was considering it anyway for other debt.

Attorney Stephen Jessup:

Sammy,

You will need to consult with a Bankruptcy attorney to determine your rights as it relates to the overpayment Hartford is asserting.

Patti:

Is it true that instead of turning over the full amount to the insurance company, you can pay them back in payments?

Attorney Stephen Jessup:

Patti,

Any potential repayment plan will be at the discretion of the insurance company. Although it is true repayment plans can be agreed to, it should be noted that the company would be within its rights to decline and such arrangement.

Judy:

I am receiving LTD from Unum. I am also receiving as retirement. I received one month of ltd I told Unum I was getting ss retirement Unum told me I was over paid for one month that I have to pay it back. I am still on LTD now so they take the amount that I get a month goes towards what I owe them. So they only pay me $15.35 a month. My question is… Can I still receive the full amount of LTD which was $1139 per month and still receive ss retirement of $1048 per month at the same time? SS office said I could because that is 2 different things.

Attorney Stephen Jessup:

Judy,

Most likely your Social Security Retirement is an enumerated offset in your disability policy, which allows Unum to reduce your monthly benefit by same. If that is the case there is no way to collect the full amount from Unum as the policy would dictate the right to offset.

Loren:

I just received my back pay from Social Security and knew I would have to pay back my LTD to my insurance carrier. I did not notice on the form that they snuck in the STD as well. I also did not use an attorney and had asked them to consider that because I have many unpaid medical bills and other home issues that need taken care of. I told them since they had offered me their attorney to use, I had saved them that expense and did not think it was too much to ask to be granted just a bit of leniency, after being told it was under consideration I find I was being strung along.

They went retro active and lowered that amount to the new SSDI payment and dates so that I owed them a month back then lowered my rate. I was trying to review all their numbers but I am off due to a head injury and a bit slower than usual in figuring things out and they did not disclose well where the numbers were coming from.

Through emails I asked them to explain this all to me and it took a few days. Here it is 4 days after I have revived my letter and EOB from them with the figures and they are already threatening to send me to collections if my check is not received in the next few days. The form they sent out in the beginning asking if I wanted to collect the full amt or take a reduced estimated amt to lower the chance of an over payment I had returned saying I would bite the bullet so to speak and take the reduced amt. At the time I was uneducated in the system and did not know I would get a lump sum retroactive to repay them. The insurance company ignored this and kept paying me. I called and was told not to worry that there would be a money if I were approved but was never sent a new form to sign.

I have already made arrangements to pay them but if they are going to get nasty with me and take me to collections, can this mistake on their part help me at all? I am insulted at being threatened after 4 days while all the time having been in constant contact with the rep just trying to make sense of the figures.

Gabby:

I was a caregiver for my brother who passed recently from colon cancer. My brother received LTD from his employer and upon his death, I sent the appropriate paperwork in to discontinue any LTD benefits and refunded the partial amount which was paid for that monthly payment. My brother had some health insurance issues with his previous employer and they were denying all claims. I consulted an attorney and we filed for SSDI which was approved about 1 month before his death and the backpay of 18,000 was deposited 2 days after his death. I have no idea what to do here. The money would be a part of his estate but honestly I am afraid to touch it. Is this money owed back to the LTD provider?

Attorney Stephen Jessup:

Loren,

You are not alone in your situation. Quite often a policy will indicate the company is entitled to collect a repayment of any money even if the error was their fault. If they were to send you to collections, their mistake would most likely not help alleviate any portion of the overpayment.

Attorney Stephen Jessup:

Gabby,

First and foremost, my sincerest condolences. The insurance company could have a right to a repayment in light of benefits paid to your brother. If there is an attorney handling the estate, your best bet would be to consult with him/her or in the alternative consult with an estate attorney.

Randy:

Greg,

My wife is on long term disability with Cigna, They hired the company Allsup to try and get my wife on SSDI, After some denials by SSDI they opted to move my wife from disabled status to workable status with them, There was a ALJ hearing scheduled when they made this decision, Upon receiving the ALJ’s decision my wife was found totaly disabled and dated back two years, Cigna on the other hand is requiring my wife to continue to look for work even though her doctor has limited her to one maybe two hours a day but they insist she look for full time work even though she cannot physically do this what should we do in this situation being she is now on SSDI.

Thank you!

Attorney Stephen Jessup:

Randy,

Has Cigna formally denied your wife’s claim for benefits? If so, please feel free to have your wife contact our office to discuss her claim to determine what rights she may still have under the policy. Additionally, has Cigna asserted any overpayments on the back benefit award from Social Security?

Lou:

Prudential Insurance Long Term Disability policy is paying monthly disability benefits that were paid for with after-tax dollars. As such, that benefit is not subject to federal income tax.

We filed a SSDI claim with Social Security and were approved. Prudential informed us we were required to do so by law. If we did not, they could bring suit against us forcing us to file for SSDI.

The SSDI dollars we now receive are subject to federal income tax at a 25% rate based on our combined income. Social Security withholds 25% of the monthly payments and forwards them to Internal Revenue as they should as authorized on our W-4V form on file with them.

Prudential Insurance then says by law they are permitted now to deduct from the amount Prudential pays us, 100% of the SSDI benefits awarded not the remaining 75% after taxes. They state that they are allowed to recover 100% of the SSDI benefits under the law, even though those earnings are taxable to us as income. Thus we receive no benefit at all, and actually lose 25% more than we are being paid every month by Social Security.

In my mind they are bending the laws and interpretations of them to steal 25% of our lawfully obtained Social Security benefits, in essence stealing Social Security benefits from their policy holder.

This interpretation just cannot be the intent of the law as it was written. Some of us are having a hard time trying to figure out exactly what the original intent of the law was in the first place. Social Security is becoming more insolvent, and we are effectively reimbursing insurance companies for their policies disability benefits and that’s not enough? They now want to recover our income taxes paid as well as part of their SSDI offset?

Social Security says they have no contractual relationship with Prudential or any other company and cannot assist me. Internal Revenue says essentially the same thing, since they are getting paid the taxes due. Prudential said I could call my congressman and work to get the Social Security disability payments exempted from taxation, and that would resolve my problem; Like that would ever happen.

Surely this case is not the only time this has happened, and Prudential is not the only insurance company doing this to some of the most vulnerable people in our population, and this could not have been the vision of the lawmakers who originally wrote these laws.

What can be done?

Attorney Stephen Jessup:

Lou,

Unfortunately, there is no definitive answer for your dilemma. You will most likely need to enlist the services of an accountant to determine what you may be able to do with respect to the taxation and if you are due any credit on account of the nature of the Prudential funds.

Lewis Meyer:

I’ve been on permanant disability for approx. 5 years. My X company’s compensation insurance company wants to give me an check for expenses of $4000 of which $800 goes to my worker’s comp. lawyer. My case is still open and I’m on disability and I have Medicare. Do I have to report or turn over the $3200 check they may send me? Or can I just keep it? They say it’s for expenses. Never received a check for expenses before.

Lewis Meyer:

Due to the injury that was work realated, my injuries being 3 herniated discs in my neck. The disability company will not let the compensation insurance company close my case. The insuranace company wants me to have a dangerous operation on my neck, disc fusions. I am reluctant to have the operation so every 2 years they send me to their doctor who states I need the operation. But not going to have it. So I can not close my case and they have to check me every 2 years. MRI etc.

Attorney Stephen Jessup:

Lewis,

I am a little confused as to your question. When you indicate you are on permanent disability, do you mean with Social Security or with a private insurance carrier?

Randy:

Stephen,

They have not denied my wife her benefits. To date they have paid her $17,760.01. My wife received $23,125.00 in back pay, her SSDI is $1666.00 a month and her LTD is $2102.00 a month. How does this work? will they be able to take the whole amount of her back pay even though they have not paid that much? And is there an offset that she only pays back the difference between her SSDI and their payments as they guarantee her 63 1/3 % of her wages when she was hurt?

Attorney Stephen Jessup:

Randy,

The carrier should only be entitled a repayment of any money received from SSDI that corresponds to a time that benefits were being paid. Please feel free to contact our office to discuss in further detail.

Rachel:

Hello,

I retired in May of 2013 due to a disability in the state of NC. I was in law enforcement for 20 years. Before retiring, I inquired if I were eligible for long term disability. I was informed that when I retire, I would lose all access to long term or short term disability. The long term disability was paid by my employer. It would be required to pay 50% of my salary.

I receive retirement disability from my pension. My question is, why wouldn’t I be eligible for LTD if I had to retire due to the disability? I have been recently researching, again and I do not understand why I would not be eligible. Also, if I am eligible, although it has been 14 months since retirement, can I still pursue LTD? Especially after being informed, by email in February of 2013 prior to my retirement, that I would lose access to long term or short term disability.

One more question, I have documentation from my medical provider regarding my disability… how likely would it be that my former employer would insist on me seeing one of their medical professionals? I was only required to provide information from my medical provider to obtain retirement disability.

Thanks so much!

Attorney Stephen Jessup:

Rachel,

Ideally you should have applied for disability benefits prior to retirement. The advice you received with respect to entitlement to coverage under the policies was correct, but your inquiry appears to have been most likely misunderstood. Typically if a person retires any coverage under the disability policies would cease, unless an application for benefits is made prior to your last day of coverage. As such your employer may have not understood your question fully. You can certainly attempt to retroactively apply for disability insurance benefits.

Jack Harkness:

Hello.

I have two separate questions.

First, I have been receiving LTD payments from MetL since Early 2010, and SSDI since late 2010.

I got married in 2012, but my wife had no income (she was pursuing her own SSDI claim for Primary-progressive MS, and had been unable to work or attend school since late 2010/early 2011).

Her (independent) SSDI claim was approved in late 2013, for about $950/mo (which doesn’t even cover her medical costs, much less her daily cost-of-living).

MetLife just sent me an annual-income report. My SSDI is about $1500, which offsets my $3200 MetLife benefit down to about $1600. Will they also “charge” me the $950 for her SSDI?

Again, the cost of her daily living expenses and her medical bills far outstrip her $950 income, which means I have *less* total money than I did before we wed, so if they do “charge” me for the $950, we could likely not pay our rent (a studio apartment in NorCal ).

Is MetLife likely to count her SSDI against me?

Completely separately, she gets horrific seizures, several per hour, which result in terrible cramps and spasms (including snapping her head back violently enough to literally cause concussion). Walking helps with her leg cramps, so she needs to do so daily (exhaustion permitting), but that doesn’t mean she can work – the seizures regularly disrupt her thought/concentration, and cause severe pain (imagine a “Charlie horse” that runs from hip to ankle and leaves visible dent in the skin from contracture, that runs from hip to ankle and lasts for hours or even days).

Before she moved in, I was often in bed all day, and my previous LTD reports reflect this. Now, she puts me in a wheelchair and walks me about – which means my “daily routine” has improved, per the report to fill out (how do you spend your days, how often do you go outside, etc.). Likewise, she has a Seizure Alert dog, who needs regular walks – and there are only the two of us to do it (so when we are both to ill to do so, one or the other of us ties him to a long leash and lets him out to the bushes near our front door, and cleans it up later).

Are these “positive changes” likely to impact my LTD claim? I’m not “lifting more than 10#” or “sitting more than 2hrs consecutively” etc. (ala my doctor’s report on my capacity).

I’m not expecting a clear answer to this second issue, just your impressions/opinion. I’m paraplegic and on Oxygen, and have neuromuscular disease.

Thank you for your time.

Attorney Stephen Jessup:

Jack,

MetLife is only entitled to offset your monthly benefit by the amount you receive from SSDI or the amount a dependent receives on account of your disability. As your wife’s SSDI claim is based solely on her disability, MetLife would not have any right to offset your benefit. With respect to the “positive changes” in your functionality, I don’t personally see how your ability to get some fresh air and go on brief walks (with which you are being pushed in a wheelchair) would give MetLife any ammunition to try to deny your claim. Please feel free to contact our office should you have any questions or concerns regarding your claim.

Lydia Young:

I never signed the reimbursement agreement from Prudential LTD. I was approved back in 2010. They are now saying they will suspend my payments if I do not sign the agreement. Can they change the contract now and require me to sign the form?

Attorney Stephen Jessup:

Lydia,

I have yet to see a Prudential group long term disability policy that does not allow for the offset of benefits due to SSDI benefits. As such I would expect that yours contains such a provision; therefore, Prudential would not be changing the “contract.” That being said, they most likely will continue to withhold your benefits until such time that the overpayment is repaid.

Jeliza:

Hello,

I was previously collecting LTD benefits from UNUM. My claim is now closed with them. I have a hearing scheduled for possible SSDI. I was told by Genex that if awarded, I probably should hold my first payment to repay back pay for UNUM.

Can UNUM Demand back pay if I no longer have an active claim with them?

Jacqueline Marrant:

My husband was receiving Long Term Disability from his job. He had applied for SSDI but before receiving an answer he died. After his death SSDI sent him a back payment of over 10,000 which was deposited in a bank account with only his name on it. Also his job sent him a check that they are now claiming as an overpayment that was deposited directly into his bank account. My husband had certain bills he owed automatically deducted from his bank account that continued as the bank was not notified of his death until a couple months later. In the interim SSDI pulled the money back out of the bank account and a payment was made to his wife who is his survivor. Now his job disability sent a letter to his estate claiming that he owes over 12,000 to them however after SSDI withdrew the money his bank account only has 800.00 in it. Since SSDI sent the check to his wife can his job disability company go after his wife even though she is not the one who owes them the money or can they just go after his estate which only has 800.00 in it. Also under the provisions of his job disability upon his death his surviving wife or child should had received 3 times his disability payments which would come to a little over 9,000. Shouldn’t they recoup the money from that anyway? Could they go after his Spouse for the balance?

Attorney Stephen Jessup:

Jeliza,

Under your long term disability policy, Unum would have a right to collect any overpayment of benefits resulting from a retroactive award of SSDI benefits.

Attorney Stephen Jessup:

Jacqueline,

I do not believe the insurance carrier would have a right to go after the wife for the death benefit she received individually. Additionally, the survivor benefit under the employer provided LTD plan is directed to the spouse/survivor and not the insured, so the carrier should not have a right to same. I would suggest that the wife speak to an estate attorney to help sort out the creditors to be paid from the estate.

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