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Do I always have to repay Social Security disability benefits to my disability insurance company? Maybe not!

Attorney Stephen JessupAuthor: Attorney Stephen Jessup

Does a disability insurance claimant have to repay an insurance company back for the money received from Social Security? Unfortunately, this answer is overwhelmingly answered by a simple affirmative “yes.” The vast majority of ERISA governed group long term disability policies contain provisions allowing the insurance company to offset your monthly disability benefit by the amount you and/or your dependents receive from Social Security benefits as a result of your disability. This also includes a right to recover any award of back benefits made by the Social Security Administration, which is usually in the form of a lump sum check. As indicated, this is the most common answer to the question posed. However, a recent Federal Court ruling from Ohio sheds an additional light on the subject. As a disclaimer, the Court’s ruling is highly fact specific and does not necessarily reflect the vast majority of overpayment repayment issues.

The Issue of Overpayment and the Maybe Not

In the case of Kapp v. Sedgwick CMS, Mr. Kapp had been on long term disability for some 8 years through his employer, AT&T’s, long term disability policy, which is administered by Sedgwick. During that time frame Mr. Kapp was paid the wrong monthly benefit amount despite the fact that he repeatedly notified Sedgwick that there was an error in the computation of his monthly benefit. All totaled, he was overpaid $162,308.21. The overpayment stemmed from his receipt of SSDI benefits. The Court notes that Mr. Kapp advised Sedgwick the day he received notice from Social Security that his claim had been approved and benefits were being awarded. When Sedgwick did nothing in response, he continued to notify Sedgwick of the error in his monthly benefit. Despite his attempts to honor his duties and obligations under the policy, Sedgwick and AT&T never claimed an overpayment and actually responded to his notifications and inquiry that the amount he was receiving under the AT&T plan was correct.

From 2002 to 2010 Mr. Kapp received his full monthly disability benefit in addition to his monthly SSDI benefit. Finally, in 2010, Sedgwick and AT&T notified Mr. Kapp of the overpayment and demanded that the benefits be paid. Mr. Kapp appealed Sedgwick and AT&T’s decision to enforce the overpayment. To no one’s surprise, Sedgwick and AT&T deemed the overpayment repayment appropriate.

The Court Steps In

Mr. Kapp filed a lawsuit in Ohio Federal Court, challenging the claimed overpayment on equitable grounds, or in layman’s terms, it isn’t fair. The Court noted that Mr. Kapp had made numerous financial decisions based on the amount of his monthly benefit; had made charitable contributions based on the benefit amount; and helped to pay for the care of his parents, amongst other things, all on the assertions made by Sedgwick as to the amount of his monthly benefit.

In rendering its decision the Court noted that applicable case law stated that even when a benefits plan unambiguously provides the plan a legal right to recoup an overpayment, “equitable principles” may limit a Plan’s right to do so. In making a determination as to whether such equitable principles bar recovery of a mistake resulting in overpayment under an ERISA plan, the Court considered six factors:

1) The amount of time which has passed since the overpayment was made;
2) The effect that recoupment would have on that income
3) The nature of the mistake by the administrator
4) The amount of the overpayment
5) The beneficiary’s total income; and
6) The beneficiary’s use of the money at issue.

After reviewing all of the information before it, the Court did note that under the Plan, an overpayment had occurred, but given the facts and circumstances surrounding the case that Sedgwick and AT&T were barred from recovering the overpayment on equitable grounds.

What It All Means

The ruling in Kapp was a culmination of circumstances that came together in a “perfect storm” of facts. The Court’s opinion should not be read to mean that an insured does not have to repay an insurance company money received from Social Security or other deductible sources of income, but it does establish that on a case by case, deeper analysis should be performed as to the company’s right to enforce repayment. Attorneys Dell & Schaefer had no involvement in representing Mr. Kapp or in his case.

There are 76 opinions so far. Add your comment now.

Michael Walkup:

Thanks for the information. I am an attorney. I mostly handle SSDI cases involving multiple chemical sensitivity, fibromyalgia and chronic fatigue syndrome. I frequently have the situation where my client is terminated from LTD after the definition of disability changes from “own occupation” to “any occupation” and/or when exclusions may start to apply for ‘mental impairments’ or ‘self-reported’ impairments. If the client is awarded SSDI that means that they are unable to do “any job which exists in the national economy of the United States”, which sounds like just another way to say ‘any occupation’. I know there are some court decisions on whether the insured has to repay the benefits paid prior to the invocation of the exclusion or definition switch. As I handle cases all over the country, it would be very helpful to see an article listing all of the decisions in the various federal circuits.

Jayne:

I broke my back in 1998. The break happened outside of the U.S., and was not diagnosed correctly for 38 days. In the beginning I naively thought I would need the weekend to recover, then it would be back to work. Boy was I wrong! After a short time, my employer put me on short-term disability, and eventually long-term. This continued for close to a year. I asked repeatedly if it was ok to continue receiving a paycheck w/out working. Time and time again I was assured I was doing everything right. Eventually the H.R. Dept. began talking about permanent disability. Still convinced I would get better, I opposed the idea. They eventually applied for SSDI for me, and filed for a Disability Claim, under a policy we were offered as part of our benefits package. The problem was, they applied to MetLife, their NEW disability carrier. At the time of my injury, we were covered by The Hartford. There was mis-communication between H.R. and MetLife, as time ticked away. Eventually my employer recognized their mistake, and re-applied with The Hartford. I was eventually approved for SSDI and The Hartford Disability. My employer called a meeting to discuss my future as permanently disabled (my back broke but I had other problems that complicated the healing process). Then they presented me with a bill for $10,000.00, stating that there had been an “over-payment”. Apparently I had been on long-term disability for too long. Remember, I asked repeatedly if I was ok and the H.R. Rep assured me that I was fine. I reminded her of that, the day I was presented with the bill for $10,000.00. All she could do, was look at the table, carefully avoiding eye contact with me, and repeatedly say “there’s been an over-payment.” So I started my life on disability, $10,000.00 in the hole. They took some of that money out of my 401k! I was too sick to fight them back in the day, and at this point feel like too much time has passed to do anything. Comments welcome!

Attorney Stephen Jessup:

Jayne,

If the action accrued in the late 90s, then most likely the statute of limitations to have contested the offset has unfortunately passed.

Ann:

I find it sad that any disability insurance company limits a persons income due to what is received by SSI. It is difficult enough to adjust to a disablility. To loose one’s health and financial standing and then to have an insurance company determine one’s income shouldn’t be more than poverty level. (because that is what it amounts to) The amount received from the Insurance disability shouldn’t have anything to do with SSI when a person is dealing with a disability.

Attorney Stephen Jessup:

Ann,

Unfortunately, the law allows for it. The only way to avoid an offset due to SSDI would be to purchase an individual policy, but the premiums for same are usually cost prohibitive. Disability policies are written to limit a person to a certain percentage of their pre-disability earnings. Even individually private policies have a cap as to the amount a person can be insured for. These limits on coverage and offsets are in place to prevent an insured making more on disability than they would working.

Brian Baker:

My situation is similar if not the same as stated, and feel the matter is definitely worth taking to court.

Craig Lordigyan RHU, ChHC:

Would you say that this falls under an estoppel since the TPA seemed to waive their right to reduce their payments?

Attorney Stephen Jessup:

Craig,

That would be the argument raised. However, as noted in the article the facts and circumstances surrounding the decision are very fact specific and far from the norm.

John:

I owe Hartford money due to over payment. Since I cannot repay it in full most likely they will stop my benefits until they are repaid. My question is after they have been paid do they have to legally continue paying me my benefit again?

Attorney Stephen Jessup:

John,

As long as you continue to meet the definition of disability under the policy, then yes, they will continue to pay you after the overpayment is satisfied.

Charles Moore:

How is it possible for a LTD insurer to claim my dependents S.S. back pay and claim it as overpayment, when the policy was on me. I don’t have a problem if I legally owe them my back pay as overpayment but how can they legally claim my child’s back pay for something they say I owe. I’m also dealing with The Hartford Co.

Attorney Stephen Jessup:

Charles,

Most ERISA governed LTD policies allow an offset for dependents social security benefits. If the terms and conditions of your policy indicate such, then Hartford has the right to offset your benefit by the amount of dependent social security you receive.

Mary:

I was approved for SS. I understand that you have stated that the disability funds must be paid back to MetLife. Is there ever a case where they will allow for installments or does the funds have to be paid in full? Can they take it from my account without having account number?

Attorney Stephen Jessup:

Mary,

Insurance companies will typically agree to a repayment plan. I would suggest you reach out to MetLife to determine what type of plan they may offer you.

K.T.:

I was on approved and paid (at 60% of my base pay) LTD for over 8 months when Aetna denied my benefits for no legitimate reason in May, 2014. I appealed their decision and just found out this week that I WON my appeal which is nice, but they are already trying to do underhanded tactics to limit my future benefits including changing my primary disabling condition to mental health AND making it retroactive back to Feb 2014 which was during a time I was on approved Medical LTD, not behavioral health. They never notified me of a change to mental health until they approved my appeal about a week ago so how can they make that retroactive? I have both physical and mental conditions which prevent me from working or ever returning to work. I want off of this treadmill of constantly living in fear of what Aetna will pull next. My situation is unique because I am now receiving pay (and back pay) again but this process has taken years off my life. I went almost 3 full months with zero income! There are no words to describe how much I hate Aetna. I want to head-off their next denial which I’m sure is only a matter of time and possibly explore a settlement. Thank you.

Attorney Stephen Jessup:

K.T.,

Attempting to classify a claim for disability as a mental health condition in order to limit the claim to 24 months is a very common tactic. Please feel free to contact our office to discuss how we may be able to assist you in the monthly handling of your claim to prevent Aetna from asserting the 24 month limitation.

Sharon:

My husband gets SSI disability and also long term disability that was reduced when he started receiving his SSI disability. Since he has normally received a SSI cost of living increase every year, are the long term disability payement reduced by the amount of the cost of living increase?

Attorney Stephen Jessup:

Sharon,

No. Typically employer provided disability policies do not allow for further offset of the benefit by COLA increases from SSDI.

Vic:

Got approved by SSA after almost 3 years. I have 4 children. The oldest child had to work part time to provide additional income, promising to repay him when I get compensated. Can I deduct those money I had to repay him from the one that I have to repay LTD considering that I have 4 kids and the dependent benefits are somehow equal to only 2 and I had to have the extra income from my child in order to provide for them? Thanks!

Attorney Stephen Jessup:

Vic,

Unfortunately, you will not be able to lessen your obligation to repay Unum by the amount you had to repay your child.

Jack:

I was receiving LTD benefits for two years from a private own occupation policy. I was finally approved for SSI disability benefits after year two. I paid the overpayment of 12,000 back to the LTD company as required.

Now do I have to pay income taxes to the IRS for SSI Disability payments for the two years, although the overpayment was sent back to the LTD carrier as an overpayment.

Thanks.

Attorney Stephen Jessup:

Jack,

As we are not tax professionals we are not allowed to provide any advice as to same. You will need to consult with a tax professional as to any tax obligations.

Pat:

I received LTD from Lincoln financial through my job. After 21 months, my social security disability went through and I received 21 months back pay. My disability income is almost $200 a month less than my LTD. Lincoln wants me to pay them back $3600 more than I received in disability and only give me 12 months to do so. I am willing to give them all the back pay I got from social security, but if I have to pay them the $3600 that puts me with about $475 less a month that I cannot afford to do. I am a widow and my bills are the same as before. Can they ask for this or can I ask them to take my back pay as a full settlement? I didn’t use them as my advocate and social security paid my advocate before I received any funds. I didn’t sign anything with them about paying them back and didn’t know I had to until about 8 months ago. We are in Virginia. Thank you.

Attorney Stephen Jessup:

Pat,

I do not understand how Lincoln calculated an overpayment that is more than what they paid you in benefits. Please feel free to contact our office to discuss the overpayment in detail.

necey:

Who do the as office send the money to me or the insurance company and if it come to me what if I don’t pay it back what happens do they cut of my ss

Attorney Stephen Jessup:

necey,

The SSA will only send you your SSDI benefits. If you do not repay the applicable overpayment the carrier can apply your monthly benefit to the repayment of same, send you to collections, or potentially file suit to recover the overpayment.

T. C.:

This isn’t a question but more of a statement, how is it that a long term disability company legally ask you to pay back your Social Security benefits? That money you paid into during the years that you worked. Whether you’re Ltd you paid into or it was an employer benefit. It’s a perk of your job. To me asking pay an insurance company back is making you a zero liability. That’s like having car insurance and getting into a car accident and you’ve been paying for insurance for years and getting into an accident that is by no means your fault and the insurance company expecting you to pay them back. To me this seems like legal robbery. What if you decide not to pursue social security disability if your spouse is making enough money for you to get by without having to fight the federal government? And you decide to wait until the age of 65 to file. You would be under no obligation to pay back the insurance company. This seems like a contradiction to the contract they make you sign. So if you get awarded money they want it back, but if you decide not to pursue this avenue then you are under no obligation to pay them back. Like myself I am 43 years old, and unfortunately I did file for SSDI. If my husband made enough money, I would not have gone through all the trouble and aggravation of fighting the federal government. I simply just would have resigned from my job. And avoided all the of the headache that I have gone through. I would have collected the long term disability because they are the ones that called me. And then just simply waited until I hit the age of retirement. And at that point the insurance company would have absolutely no recourse to come after my money. My social security money would be mine free and clear. So I just don’t understand this double standard that insurance companies have. And how the federal government allows for this to happen. My people haven’t decided to make a class action lawsuit against long term disability companies. They are multi billion dollar corporation that one somebody is awarded Social Security disability benefits and starts you off in the hole from the word go. Ltd companies do not care about you, see you you are just a number. And being disabled is not cheap. Like myself I have 14 different doctors that I see, and I have a very rare disease the more than likely will end up telling me within the next 5 to 10 years. And to be quite honest I would rather get my money and take my chances in court and spend what little time I may have left with my family, and enjoy possibly taking my family on our first family vacation. Granted yes I will be in a wheelchair, but this may be my only time I can do this. There should be extenuating circumstances or a clause written into this agreement you make with the insurance companies. If the patient has a potentially terminal disease, why make them dirt poor. To me it just seems a little unfair to make insurance companies richer, while the patient still suffers a little bit more and just adds insult to injury. And like I said it just makes us a zero liability to them. And they feel like they’re the ones left holding the bag while the government makes up their mind but isn’t that what premium payments are made for? Insurance companies are in the business of making money. So in retrospect I wouldn’t necessarily call this a perk of a job, granted yes it does keep you afloat for a time but when you’re only getting paid 60 percent of what you used to get and then they take taxes out of that so technically you’re only getting paid maybe 40 percent. They should base your back pay on what they actually paid to you. Not based on pretax dollars. I didn’t see that portion of the money because I played it smart and had taxes taken out so why should I have to pay that part back. And then I had to claim it on my tax return. So something seems a little wrong with the system. So the perk is actually a slow ticking time bomb that eventually catches up with you and leaves you dirt poor in the end. You worked years to save up the Social Security benefits only to have some insurance company come along and make you sign some document and take it all away from you. In my eyes that money isn’t theirs. They get their monthly premium, some very large corporations. And if you think about the thousands of dollars that they are getting some disabled people it’s almost enough to make you sick. Because like I said if I never applied for SSDI this would never be an issue in my money would still be mine. Not some money hungry insurance company who’s done nothing but make my life a holy hell for 2 years. I work with Liberty Mutual insurance company out of Dover New Hampshire and I have to say that they were probably the worst insurance company I have ever dealt with and I am glad that I don’t have to deal with them anymore.

Attorney Stephen Jessup:

T.C.,

We certainly appreciate your frustration, but the simplest answer is because the policy states they can. These provisions have been upheld in court as legally enforceable. It is one over the larger factors as to why premiums for employer provided policies are so low.

Steven:

Hello My name is Steve and I had been on LTD for the last 24 Months and was aware of reimbursement, but it did not specify how I have to pay it back in the agreement… there asking for the one large sum of my SSDI back pay, which will send me into a poverty tail spin. If its not specific on the agreement, whats the best way to handle it without causing a crime against my self, please I could really use your help. I have DDD and spinal Stenosis and can’t go back into what I did for a living and have very limited Education. I’m not looking to screw anyone over and just trying to survive on a daily basis. So if it’s not specified to pay back in one large sum, do I have a leg to stand so to speak?

Attorney Stephen Jessup:

Steven,

You can request a repayment plan or ask that they withhold a portion (or the entire amount) of your monthly benefit to apply towards the overpayment.

Kevin:

Hello, I have a good question for you. I live and worked in TX. My employer’s (ERISA) plan provides LTD at 50% of base pay at no cost to the employee. I elected to pay an extra premium held out of every paycheck for “60% of base pay plus bonus.” Now that I’ve been approved for SSDI, I understand why I have to reimburse Aetna (LTD) for everything I received in LTD pay for the 50% part of my salary but why the remaining 10% of base pay plus bonus for which I paid a monthly premium? If they are going to collect the remaining money, then why was a charged a premium?

Attorney Stephen Jessup:

Kevin,

The policy most likely reads that the carrier can reduce your monthly benefit by the amount you receive from SSDI, and your monthly benefit is 60% of your pre-disability earnings. Therefore, without a distinction in the policy as to only reducing from the 50% then you will be liable for repayment for the whole amount. At the end of the day the amount you receive between the carrier and SSDI still represents 60% of your pre-disability earnings.

William C.:

After receiving ltd payments from Unum for two years, what if I either;

A) simply do not apply for ssdi, for whatever reason, with Unum then stopping payments …. which is fine with me

Or

B) apply by myself (instead of using unum’s genex) and if not approved for ssdi then do not appeal?

The bottom line question is what ‘remedies’ would the likes of Unum have if the ltd recipient simply said ‘enough’ and accepted no further Unum money and did not subsequently apply for ssdi?

Thank You

William

Attorney Stephen Jessup:

William,

If you were to voluntarily stop receiving benefits it wouldn’t be likely that Unum would have any further dealings. That being said, you would be without any potential income sources if you are unable to return to work.

Nelly:

I have a question. I currently receive ltd from Aetna and I do have Allsup working on my SSDI claim. I’m concerned about the overpayment. Also, does Aetna have a payment plan to repay overpayment if I’m approved? This will cause a heavy financial strain. How do they expect people to survive? If I have to make a full payment that will leave me with nothing. I’m just lost.

Attorney Stephen Jessup:

Nelly, you can certainly request a repayment plan on the overpayment, but that does not mean Aetna will agree. If you haven’t received back benefit funds the smoothest transition would be not to spend the back benefit check and send the applicable amount to Aetna.

Joseph:

I was in an auto accident that left me permanently paralyzed. Unum has been paying LTD payments, with SSD payment offsets for my children. When the youngest reaches 18 years old and the SSD payments stop, will UNUM have to pay more to honor my 60% wage threshold?

Attorney Stephen Jessup:

Joseph, when the DSSDI is no longer being received by your dependent, Unum would be responsible for making up the difference back toward the initial benefit amount.

Maria:

I have an interesting dilemma…

I applied for Disability for myself and my son in 07/2013 with SSA after my suffered a massive severe brain injury caused by an asthma attack that placed him respiratory failure. After (2) months of working all day, being in ICU with him all night, my body gave out to serious health/PTSD issues. My employer had Aetna LT disability insurance. I applied with them in September 2013 and explained the separate SSA filings and my progress to date. They tried to get me involved with Allsup, but once I explained that the filings were already done, Allsup sent me a letter saying they would not be able to help me. Aetna paid my claim from October 2013 until March 2014, when I asked them to stop payments due to receipt of an award letter from SSA on MY application. SSDI began paying me, and (2) child benefits (equal to 50% of my benefit and divided by 2 children-in effect 25% of my benefit to each child) with an effective date of Jan 2014.

No payment was made by Aetna in April 2013, but a payment was made in error in May 2014. Unfortunately I did not realize it until after I’d spent it.

At this point, Aetna initially calculated the overpayment due them. There made an error of requesting ALL monies that had been paid instead of only the amount equal to the SSDI & child benefit(s) per contract language. They were also including both child benefits in the repayment calculation.

In January 2015, my son’s application for SSI was approved with a RETROACTIVE date of July 2013. SSA made payments for 2013, re-allocated his child benefit that was paid in 2014 against his SSI payments (they do not pay the benefit 2x) and issued payment for Jan 2015.

We are ALL in agreement that his SSI payments are not recoverable under Aetna contract, however, Aetna is saying because 2014 was initially paid as a child benefit and later re-allocated they are entitled to these monies. They want $9450 from me and my calculation (not including them, correcting the initial error, and increasing the living child’s benefit as of March 2015) show THEY owe me $4500. I have this on spreadsheets. My contention is that because SSA applied his child benefits against his SSI amounts owed, these are not recoverable. I have sent Aetna at least 5-6 letters and appealed this, the initial calculation, and the ignoring of the disabling health conditions….but am at a loss on how to proceed. They just keep ignoring the issue and have turned me over for collections (which I’ve disputed).

To further complicate the issue, the child receiving SSI died Feb 2015, and the entire child benefit was give to the other (non-disabled) child effective March 2015.

What are your thoughts? Help? Please?

Attorney Stephen Jessup:

Maria, we would need to see all the correspondence and award letters. Please contact us with same and we will be more than willing to review for you.

Raphel:

Once I get my retroactive Social Security award benefit (Admin. Law Judge gave me verbal confirmation that he was approving/awarding my SSDI claim) I plan to pay off all the medical and other various bills that have accumulated and gone into collections because my LTD provider cut off my benefit at 28 months when they determined I no longer met their definition of “disabled” (even though SS says I am).
I am strongly disputing this change of status with the LTD provider anticipating a long, drawn out fight.
Is filing personal Chapter 7 bankruptcy a viable, legal option to possibly keep the offset funds that the LTD provider tries to collect from my SSDI retroactive award, out of their hands, so to speak? In essence possibly leaving only one creditor in the bankruptcy filing- that is the LTD provider, being owed anything. I see it as being proactive in putting my financial house in order by cleaning up my oldest past due accounts (that are mainly medical- directly related to my disability).
Just curious if my reasoning here is legally viable in that I will not be able to pay the full off-set monies back to ANY entity if the funds are no longer available, only because they have been used to pay older debts.
Thank you for reviewing.

Attorney Stephen Jessup:

Raphel, you would need to consult with a Bankruptcy attorney as to what your options would be .

Dennis H.:

My name is Dennis. I was recently awarded my disability through ss and now owe met life most of my back pay. My attorney got 6000 dollars of my back pay. I have been told that met life must deduct that from the over payment. The plan is an erisa plan. Is this true? Thank you

Attorney Stephen Jessup:

Dennis, the overpayment repayment will be less the attorney award – so you will not be responsible for repaying the $6000 paid to your attorneys.

Chris:

My question is quite opposite the others. I retired in December 2015 after being on lon-term disability for 2 years, short term 6 months prior to that. I receive a pension from my company plus social security (at 63 years of age). I had been required to apply for social security disability during this time and finally won my case in June 2016. It is now October 2016. The attorney’s were paid and back pay was sent to my bank account where it remains. When i contacted them, the attorney’s office said they were out of it and it is up to me to contact my company in regards to paying them back anything I might owe. The HR department felt I did not owe it back but from everything I’ve read I am not sure. I called the appropriate person at the main office who took my information and said she’d have to look into it. I left several messages as well and it has been 5 weeks and I still have not heard from them. My question is, how long do I have to wait to hear from the insurance company until I can use/invest the money? My policy is from 1979 and I paid the premiums. I worked for the same company for 34 years prior to my disability.

Attorney Stephen Jessup:

Chris, there stands a likely chance you may not despite your efforts. Arguably, the 3 years Statute of Limitation to bring any action under the policy would also apply to the carrier to try to seek repayment.

Conner:

We are dealing with Sedgwick. My husband has been off work for a year now for cancer. His SSDI got approved and now Sedgwick wants their money back. You pay insurance premiums to have this coverage and then they want you to pay them back. What good is it to pay to have them in the first place? They went a few times where they lapsed in payments causing a hardship on us with our bills. I guess they think paying you when it’s convenient for them is acceptable. Therefore, when the lump payment from SSDI came in we were so relieved. We had to use it to pay mortgage payments and catch up on bills. My husband wants to hire an attorney to look into it. I feel that if your paying them to have this insurance, you shouldn’t have to pay them back. Just looking for an honest opinion.

Mischele:

I have been on disability for 8 years. I was first on Unum STD then LTD. I filed for SSI and was approved very quickly (about 60-90 days) for migraines. Unum has been paying the difference between what SSI pays to me amd my children to match 60% of my income with previous employer about $465 per month. My daughter is getting ready to graduate high school so the amount expected from Unum would increase by $1265 ( her SSI award). I received a phone call from a Unum representative yesterday stating that because my claim of disability was for migraines it was a self-reported illness. And that self-reported illnesses or only covered for disability for 12 months. I asked him why Unum had continued to pay for eight years and he said that was a good question. I am very afraid of losing this income of almost $1700 per month once my daughter graduates from high school. I’m even more mortified that I could have to repay Unum for all of those years that they paid me and disability checks that they are saying that they should’ve only paid me for 12 Months. However, Unum completed a review almost every single year and a 12 month limitation on my benefits was never brought to light at anytime. The representative that I spoke with at Unum said that he was sending out a request for medical records as well as a log for me to keep track of my migraines and send back. I don’t understand why he’s asking me to keep the slog went at the same time he’s basically stating my benefits should not have been paid. I, do, have other illnesses including cervical spine issues which contribute tremendously to my migraines. Moreover, the medications I take for my migraines make it impossible for me to drive and/or function on several days of the week. What can I do? I attempted suicide 2 years ago due to pain and no hope of getting better. Phone calls like this less than 2 weeks before Christmas certainly do not help anyone’s state of mind. How can I fight back against Unum? Can I fight back?

Attorney Stephen Jessup:

Mischele, yes, you would certainly have rights to appeal any denial of benefits in the event they terminate the claim. The self-reported symptom condition limitation in Unum policies is very common; however, it is not common for benefits to be paid for 8 years and then the carrier asserts the policy language. It calls into question whether your policy from 8 years even contains the limitation as it is relatively new. Please feel free to contact our office to discuss your claim in greater detail.

Kathy:

My husband fell ill and has a ltd claim through Gaurdian life. He was awarded a lump sum award as he applied for SSDI and only approved for a short time by SSDI. We took lump sum and gave it to Gaurdian, and appealed SSDI and 3 years later won. Except ssdi gave us a weird explanation stating he wasn’t totally disabled until two years into the claim. But he’s got SSDI now indefinitely. We didn’t expect anymore lump sum awards the way it read to us it was like a wash… but we did in fact receive ANOTHER lump sum award by SSDI. My question is: does Gaurdian have rights to the SECOND lump sum award? Or could there be a statute of them only being able to take the first award which they did. We’ve tried to get them to talk to us about the award so we don’t spend it until we know what the rules are. But so far they don’t return calls, or let us know. We don’t want to use this lump sum award if it’s to go to them. I would think there should be only one lump sum award per policy which would be awesome. So my question is can they keep taking the lump sums awards if there’s more then one?

Attorney Stephen Jessup:

Kathy, if Guardian was paying the full monthly benefit during the time frame the new lump sum benefit from the SSA represents, then yes, they would have a right to recovery and continued offset. If they are not responding to calls I would recommend you send a copy of the award letter via mail.

K.Lee:

This is awful to see so many stories of no real help to recipients recieving benefits for thier illness. I am a type 1 diabetic with signs of kidney failure neurothapy in both hands and feet, gastropareeses of the gut, a bad heart due to hyperthyroidism that was ablated with radiation and more. I was recieving benefits from my father but hes not deciesed. Retirement benefits and the ssa decided I was not disabled enough under thier law. I have now been mailed a 15,000 dollar overpayment statement after a few years of being cut off. I have not been able to work since being cut off. I’ve gotten sicker but no real way to prove anything since diabetes specialist will not see me due to my health insurance that they don’t take and noone to listen. I never applied for this myself, my mother did when I was younger because I was very sick as a child and it has only gotten worse since adulthood. I do not know what to do, there is no way I’ll ever be able to pay this back. They won’t even explain how it even got that way. I’ve been reading up on this issue to have learned this much myself. I have a little girl diagnosed with severe austism, she recieves ssi, I am in fear that what she recieves will be thrown back at her as has been done to me when she reaches legal age of 18. It is not right that because the law says the ssa can send you a large overpayment statement like I never was sick to begin with after all the docters an documents that I’ve seen or had they get to ruin every one’s life that ever applied or signed their children up with special needs on low income an sickly only to have to suffer as soon as thier 18 or older. I just don’t undestand how can something so unjust be legal and nothing really to be done about it.

Brad:

Social security deposited a check in my account for 2012 – 2016, then Aetna came a few days later and took it out. Now i got a tax form in the mail from Social security that i owe taxes on the full amount they put in my account though Aetna took taxes out in my disability check since 2012. I got nothing from Aetna says they took the money as back pay. How do i show the IRS I already paid taxes.

Attorney Stephen Jessup:

Brad, you will need to consult with an accountant or qualified tax professional to discuss how to best report to the IRS. You can also review this article post from our website.

Linda:

I was just approved for my ssdi… I have been receiving unum ltd payments in the amount of 3,000 per month, 60% of my income since August 2015… in my letter from Ss, it stated I would receive back payment in the amount of $22,000 on March 17… does Ss inform Unum? Do I inform Unum? What can I expect… I had the same job for 43 years… ty so much.

Attorney Stephen Jessup:

Linda, yes, you will need to inform Unum that SSDI was awarded. They will request a copy of the award letter and calculate any applicable overpayment repayment due.

Belinda:

Got a decision of Fully Favorable… now I have questions… I know any back pay I receive will go to my LTD carrier…Liberty Mutual. My question is what is the back pay is not enough to pay them back… also… am I understanding this correctly that if my LTD finds I can do “no work” they continue to pay the difference of what SSDI is awarding me and what they were paying me? If they can only take the back pay as over payment that means I no longer owe them anything else? Also… how long would my LTD be paying the offset difference? Is that limited to a certain time frame… I am at the phase of determining if I can do “no work”… I have MS and Fibromyalgia and a long list of things those diagnoses bring… cronic fatigue, sleep apnea… and take a ton of medications…

Attorney Stephen Jessup:

Belinda, as you have multiple questions and moving parts to your claim, please feel free to contact our office to discuss further.

Jim:

I just received my lump sum payment from SS. It describes my back payments beginning 2/14 with a cost of living increase 12/14 and a second increase 12/16. My question is whether UNUM can use my current payment as the base or is the original amount my initial benefit amount. The difference amounts to about $600 which would be a nice surprise. Since they can’t adjust my payment for COL increase I just want to know if that is the initial amount received or the amount I am currently receiving. At least I put their 85k in a money market until I get their repayment option so I will make a little interest anyway. I am supposed to get a letter next week regarding my repayment.

Everyone should understand that your LTD back pay from SSD is not yours and DONT SPEND THE MONEY!! Your private insurer will come looking for it so don’t spend it. I feel for all these people that think they got a windfall and now have to pay it back.

Attorney Stephen Jessup:

Jim, I have yet to see a Unum policy that computes your SSDI offset to include your COLA increases. The standard Unum policy will only offset the amount of the initial award.

Julia:

Hi! I have been on private long term disability since April of 2014 due to severe neurological problems stemming from a botched spinal tap. I receive $3611 a month in disability and was recently advised that legally I had to apply for social security. At everyone’s surprise, I was approved within a month and out of nowhere $27,000 was deposited into my bank account which they said covered March 3016-May 2017. My private disability company claims I need to pay them that amount back. They will send me a breakdown but my representative thinks it will be in full. Does this sound legitimate? Social security is also giving me $1848 a month and private disability will pay the difference to keep me at the $3611 which I understand and had previously been explained to me. Just a bit confused about this $27,000 being paid back in full. Any input would be greatly appreciated.

Beverly:

My former employer, AT&T, reduced back disability to offset California State Disability insurance payments, not SSDI. I maybe misunderstanding, but is the offset only applicable to back pay from SSDI? I did not receive back pay from SSDI when my claim was approved.

Attorney Stephen Jessup:

Julia, yes. If your policy indicates SSDI is an offset under your policy, then the carrier would have a right to recover any overpayment stemming from a back benefit check from SSDI.

Attorney Stephen Jessup:

Beverly, SSDI is just one source of “Other Income” subject to offsetting a policy. State Disability, worker’s compensation and retirement benefits are also common sources of “Other Income” subject to offset in almost every disability policy.

Angie:

I received for LTD from 8/14 until 8/16. I was approved for disability with Social Security back dated to 10/14. My SSDI payment is less than LTD was. The LTD company wants all of the SS back payment and any additional payment for my minor child. I went a year without any income and lived off of credit. It seems like that should be accounted for. It seems wrong that I paid a premium for LTD insurance and am now required to give them everything I have including anything I receive for my child.

Attorney Stephen Jessup:

Angie, why did your benefit stop in August of 2016? Was your claim denied? Please feel free to contact our office to discuss your claim/situation further.

Denise:

I’ve been receiving ltd for over 20 years, paid back my overpayment to reliance standard 15 years ago. Received a letter last week requesting ssdi information back dated 2002 to present. Very confused.

Attorney Stephen Jessup:

Denise, as in the letter is dated from 2002? Or RSL wants information from the SSA going back to 2002? If it is the former – I would call RSL to find out what the request is about and if it is the latter it may be that RSL is doing an accounting to make sure it applied the right amount in an offset. Carriers will typically do this at some point in a claim, it’s just not common that it took so long to request given how long you have been on claim. Regardless, calling them for clarification may be the easiest route to find out what they are looking for.

Tom:

I was receiving short term disability payments (full pay) from my employer. Then after about 5 months, it transferred to long term disability payments through a policy I purchased through work. I just received a lump payment from SSDI (finally being approved – approximately $12K) and a portion of that was an overpayment (approx. $4500) which I had to return to the LTD company.

My question: is the balance left (approx $7500) from the SSDI payment mine, or do I have to inform Social Security because I was paid my full wage from my employer for a few months?

Attorney Stephen Jessup:

Tom, you will need to consult with a SSDI attorney as to any money that may be owed to the SSA on account of your work earnings.

Tricia:

What if the LTD company is paying less $1015.74 than what your social security disability pays monthly $1640? LTD company is stating their is an overpayment. Award was for 11 months.

Attorney Stephen Jessup:

Tricia, regardless of the amount paid by the LTD carrier and SSDI, there would still be an applicable overpayment if payments were made by the LTD carrier for a time the SSDI awarded back benefits. However, the LTD carrier can only recover the amount they actually paid, and not require all the money back – meaning they are at most entitled to $1,015.74 a month repayment (based on your scenario). However, please note that if your policy has a “minimum monthly benefit” (which is usually around $100 a month) to be paid regardless of all sources of income, then in your scenario they would be entitled to only $915.74 back each applicable month.

Pella:

I was receiving LTD for about a year and won my SSA case. I was awarded back pay. I knew nothing about having to pay Aetna back nor do I recall any documentation sent by Aetna about this (I had this policy through an employer). I am a single mom and that backpay was gone quickly. However, Aetna cut me off around the time I won disability. I decided after 6 months to appeal. I told them I won SSA and now I am worried they will want my backpay which is long gone. Can they garnish my SSDI? Am I still entitled to LTD benefits if I win the appeal? My SSDI is less than what my LTD was. If I don’t provide the SSA award letter then can they still pursue me?

Attorney Stephen Jessup:

Pella, Aetna cannot garnish your SSDI benefit from the SSA. However, they can pursue their rights to recovrery of the overpayment. If you win your appeal they will take the net amount they owe you (Aetna benefit less amount you receive from SSDI) and apply it until the overpayment is satisfied.

Maria:

I have been receiving LTD benefits for 4+ years now, due to various health problems, including RA, severe bilateral hand osteoarthriris, and chronic soft tissue calcification, for which i’ve had 5 surgeries. My LTD insurer recently closed my claim and i am currently appealing, as my disabilities are ongoing. In the interim, i had my SSDI hearing and am awaiting a decision. My question is, if i am awarded SSDI benefits with backpay and my LTD appeal is denied, am i still required to pay back my LTD, since they closed my claim?

Attorney Stephen Jessup:

Maria, the carrier would still have a right to repayment for any overlapping period of time they paid you a benefit that the SSA also pays you for. If you are awarded SSDI benefits it is very important you advise your carrier of same as receipt of SSDI is evidence of disability that will have to be considered. If you would like to discuss your claim further please feel free to contact our office.

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