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Can I file for disability insurance benefits if I was fired before I stopped working?



Attorney Victor PeñaAuthor: Attorney Victor Peña

The short answer to this question is, yes. However, whether the claim will be approved depends on a number of factors. The crux of the claim would hinge on whether you were disabled under the terms of your policy before you were fired.

Under most group disability policies the date of termination from employment would mark the end of the employee’s eligibility for coverage under his or her disability policy and a disability claim by that employee with a date of disability after the date of termination would certainly be denied.

To be successful in a claim filed after the date of termination a claimant would have to show that he was effectively disabled before he was fired. A Michigan Federal District Court recently decided a case dealing with this precise issue.

In Hipple v. Matrix Absence Management Mr. Hipple sought disability benefits from an ERISA governed plan. Mr. Hipple was terminated from his employment and subsequently filed a claim for disability benefits. Matrix denied Mr. Hipple’s claim asserting that his employment was terminated for cause and, therefore, he ceased to be eligible for coverage.
Specifically, Matrix assumed that because Mr. Hipple continued to show up to work until his termination on June 6, 2012, he was not disabled before that date. That assumption, according to The Court, is contrary to Sixth Circuit precedent.

The Court explained that an employee can be present at work and receiving a paycheck for his labor and, at the same time, be “disabled” under the terms of the employer’s benefit plan. Furthermore, “a denial… resting on an unverified assumption that the claimant could not have been disabled because he was present at work—[is] arbitrary and capricious.” See Hawkins v. First Union Corp.

In denying Mr. Hipple’s claim, Matrix did not evaluate the medical evidence to determine whether Mr. Hipple was in fact disabled before his termination—i.e., while he was still a participant in his employer’s long-term disability program. Matrix was therefore wrong for denying Mr. Hipple’s claim.

Under the terms of his employer’s long term disability program Mr. Hipple would be entitled to benefits if his disability arose while he was still a plan participant—even if he submitted his application after his termination.

There are 20 opinions so far. Add your comment now.

Lisa:

I was fired from Pfizer the day before I was to take short term disability. My short term disability was to begin on 9-27-17, and I was fired on 9-26-17. The reason given was that I sent an email back in July 2017 that was not compliant with Pfizer policy (two months prior).

Also, I requested STDisability on 9-18-17 and was in process of completing paperwork. Now, I have no job, and cannot afford surgery or any other kind of rehabilitation as COBRA is $1515 per month for me and my son.

Please advise me and my family if able.

Sincerely,
Lisa M.

Attorney Stephen Jessup:

Lisa, what is the status of the STD claim? Did you ever file one? Please feel free to contact our office to discuss your situation in detail.

Michelle:

My job is causing me great stress and I had a breakdown at work tonight. I was hospitalized a few months back for anxiety and collected short term disability. I also have a back injury that causes me great pain which I also collected STD for but was told by my employer if I didn’t return I would be terminated. Instead I returned and they changed my job title. I am fearful that I will be terminated after this breakdown before I have a chance to go out on disability. My anxiety is so bad that I couldn’t find an elevator where I work that I use daily.

If my job is causing me to be temporarily disabled. Both the stress and having to walk 7 or miles on an injured back is there anything I can do to make sure that I am covered?

Attorney Stephen Jessup:

Michelle, if you are terminated your coverage would arguably end as of that date. The only way to ensure coverage is to file a claim for STD before any termination date. As you have experienced that process in the past and returned to work as you were in fear of losing your job, please note that if you are on claim and your employment is terminated you would still have your legal rights under the STD and LTD (if available) policies. Please feel free to contact our office to discuss your situation in greater detail.

BRIAN S.:

MR JESSUP,
I’ve had bad knees for the 7 years or so. In june of 2017 the surgeon took xrays and stated that my knees both needed to be totaly replaced, in fact he couldn’t believe I was still working, as I am a chef and always on my feet. After my doctors appointment I went to work and told both bosses that I needed surgery and had the paperwork with me. Work did not want to see the paperwork they just wanted to know when. I told them right after new years and they agreed saying it would be a slow period.

The last week of november 2017 in inquired about the 12 family f.M.A act with means they had to pay me the first 12 weeks I was out. They agreed, however a week before the surgery they terminated me for no reason. They didn’t even do it in person, it was on the phone! I rescheduled my surgery to march 7 2018, however I don’t know what to do about disabilty. Do I file a claim before surgery? Can I even file a claim? Or wait til march 7th? Thank you for your time,

BRIAN S.

Attorney Stephen Jessup:

Brian, as your employment has been terminated your coverage under any disability insurance policy from your employer most likely ended as of the date of the termination. As such you would have no disability policy to even make a claim under. The only guidance I can possibly offer would be to suggest you speak with an employment attorney to determine if you have any rights against your employer arising from the termination. Although we do not handle such cases, we could possibly assist you in getting in touch with an attorney who can better advise you. Please feel free to contact our office to discuss.

Joan:

I was approved for std from my employer. Then they terminated me. I live in Wisconsin. Will I still receive my std benefit?

Attorney Jay Symonds:

Joan, STD coverage is determined at the time you stop working and in your case you were eligible and approved. Once on claim, your employment status is no longer relevant and should have no impact on your continued eligibility for benefits as long as you remain disabled and satisfy the STD plan requirements.

Elizabeth S.:

The answers to the questions above state exactly the opposite of what the article they are commenting on is stating. The comments say you absolutely cannot file a claim after you are terminated and the article above it says you can.

In denying Mr. Hipple’s claim, Matrix did not evaluate the medical evidence to determine whether Mr. Hipple was in fact disabled before his termination—i.e., while he was still a participant in his employer’s long-term disability program. Matrix was therefore wrong for denying Mr. Hipple’s claim.

Under the terms of his employer’s long term disability program Mr. Hipple would be entitled to benefits if his disability arose while he was still a plan participant—even if he submitted his application after his termination.To be successful in a claim filed after the date of termination a claimant would have to show that he was effectively disabled before he was fired.

Attorney Jay Symonds:

Elizabeth, every claim scenario is different and the resolution is based on the specific facts and circumstances of the particular claim. If you have a specific question please feel free to contact our office and speak with one of the attorneys to discuss you situation in detail.

April J.:

Hello. I am 6 months pregnant and have been paying into my short term disability and am due to go out on maternity leave in June but now my job is trying to fire me over an unrelated incident.

Attorney Jay Symonds:

April, that is a terrible situation. I suggest you contact an employment lawyer to assist you in protecting your rights.

Bobby:

I had a mini-stroke on November 30th. I was hospitalized for three days and used personal time for those days so I lost no salary pay. I have over the last three months had increasing issues and the last two weeks of March I was off work but again because I worked partially from home and then used personal vacation time I lost no pay… Because my employer was giving me issues with missing work, I discussed with my doctor going on short term disability and on Sunday, 3/25 I filed the claim online. I went into work the following morning and planned to talk to the owner about going on leave until I could get through the medical appointments and procedures the doctor wanted to do… when I arrived at the office I was informed my position no longer was needed and they were taking it in a different direction… I was then informed by the insurance company last week that I wasn’t entitled to benefits because I had no lost wages and I was terminated.

I am confident that the company terminated my employment because of my disability but of concern at the moment is Mutual of Omaha’s position that I had no lost wages and no basis for a claim. I filed before termination and had a recorded disability prior to termination… is there position legally sound or because I had a medically documented disability and filed prior to termination, are they required to pay my claim benefit?

Attorney Cesar Gavidia:

Bobby, thank you for your question regarding your short-term disability claim. Despite the severity of your disabling condition, your policy may require that in order to recover benefits you must have a loss of income/wages. Your plan may also offset any short-term disability benefits by any salary continuation that you receive from your employer. You should request a copy of your short-term disability plan from your employer and carefully review the terms relating to recovery of benefits, and specifically whether you must have a loss of income/wages. If you have any further questions, please contact our office and ask to speak with a disability insurance attorney.

KELLY:

To the attorney’s,

After reading the article above and then the responses from the attorney’s, I am very disappointed that attorney’s do not fight for our rights. This is why corporations are allowed to get away with this. If you have a case as listed above in the article, why are you afraid to figh?. As a Nurse, I see my patient’s going through pain and to be kicked when they are down by not having an attorney fight for them makes me question why you chose to be an attorney at all. I hope there are a few attorney’s out there that would take a case, not for the sure win but for the principal and helping to either enforce the law or help change it.

Now my husband is sick and was terminated, I will continue to prove this is wrong, as long as it takes.

Kelly

Mr. Hameroid:

A timely (within 180 days) ERISA STD appeal with proper 3rd party medical evidence is confirmed as being received by the automated system disability company 90 days ago (to include the 45 day extention…I live in the district of the 6th Circuit Court), but no response of any kind since. Before I was denied, the case manager opined I would probably need to file for LTD. I was attempting to be healed before that and could have, if my treatment could have continued for the requested additional 6 weeks to correct the problem, 12 wks total. Still under medical care and have good prognosis for a RTW (if they want me) with proper treatment. Before I was on STD, I was a productive employee and was not a discipline or attendance problem, but have been on STD/temporary LTD in the past with said company. What to do now?

Attorney Jay Symonds:

Mr. H, have you contacted the carrier to confirm receipt of the appeal and check on the status? While the automated system may reflect receipt, verbal confirmation is always a good idea given that once received “human error” can misplace or even lose a timely submitted appeal. What’s more, although the lack of any communication is unusual the carrier can, in certain circumstances, “toll” or extend the deadline beyond 90 days to make a determination. Although in such circumstances they are required to provide you with written notice and an explanation as to why they are taking the extension.

Mr.H:

I have not contacted them as of yet. If it would be prudent, I will do so.

Nicole S.:

I have a injury in April of this year. I continued to work but notified my employer that I would need surgery. I was terminated on may 8the the same day I filed my short term disability claim. I was paid bi monthly so my company paid my premium from my check 5/10/18 and on 5/25/18. The insurance company said Im not eligible because I’m no longer employed, is this correct?

Attorney Victor Peña:

Nicole, if you were disabled under the terms of your policy before you were fired then they should not have denied your claim on the basis of your being let go. However, if your date of disability is after you were let go then you may be out of luck. If you believe you were fired because of your disability you should contact an ADA attorney as soon as possible.

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