Can I submit a long-term disability claim if my employment has been terminated?

It is not uncommon for employees to struggle and suffer through sickness or injury and work, even if working is counter-intuitive to their own health and effective productivity at their occupation. Unfortunately, these employees often find themselves as targets of work-force reduction or layoff, because despite their best efforts they are unable to keep up with their employer’s expectations and requirements. Regardless of the legality of this type of employer termination strategy, it leaves the sick employee in a terrifying predicament. It is often at this point that the employee decides to apply for long-term disability benefits under their employer sponsored long-term disability plan. However, depending on the circumstances, they can expect significant challenges and even the possibility of the disability insurer arguing that the employee lacked coverage. In most cases, the employee will be told by the disability insurer that their coverage ended on their last date of work, and that the employee lacked coverage for any subsequent claim of disability. However, the employee could prevail in their claim even if their employment was terminated prior to the submission of their disability claim.

Such was the case for Eduardo Nieves, who had worked as a satellite communications technician prior to his disability. After undergoing spinal surgery Mr. Nieves returned to work, however, continued suffering from spine and shoulder pain. Despite his unwavering work ethic and commitment, Mr. Nieves found himself among other fellow co-workers who were terminated following a decision by the employer to reduce its work force.

Mr. Nieves submitted a request to his employer to be allowed to apply for short-term and long-term disability insurance benefits through the employer sponsored long-term disability plan with Prudential Life Insurance Company of America (Prudential), however, the employer refused to provide Mr. Nieves with the necessary application forms. Notwithstanding, Mr. Nieves contacted Prudential directly and applied for benefits. Not long after applying Prudential informed Mr. Nieves that his claim was being denied on account of lacking coverage on the date following his last day of work. In other words, Prudential deemed him covered only through his last date worked, and since, according to Prudential, he had performed all of the duties of his occupation through his last date worked, his date of disability would be the following day, the first day he did not perform any of the duties of his occupation.

Mr. Nieves appealed Prudential’s denial, however, his appeals were denied and he was forced to sue Prudential in U.S. District Court in Arizona.

In an interesting decision, the court found that Prudential had arbitrarily selected the date following Mr. Nieves last day worked, March 11, 2015, as his date of disability, since no where in the record had Mr. Nieves claimed March 11th to be his date of disability. Prudential attempted to argue that it was impossible for Mr. Nieves to be disabled from his last date worked since he had effectively working performing his occupational duties through that day and therefore would not meet the definition of disability.

The Court, citing to the 7th Circuit Court in Hawkins v. First Union Corporation Long-Term Disability Plan, 326 F.3d 914, 918 (7th Cir. 2003), reasoned that there is no “logical incompatibility between working full time and being disabled from working full time” as “a desperate person might force himself to work despite an illness that everyone agreed was totally disabling.”

In the case of Mr. Nieves, because he had attempted to submit his disability claim prior to his employment being termination and he had the necessary doctor support, he was successful in establishing that he was a covered employee under the disability plan. This is distinguishable from a case where someone attempts to establish a disability claim with a date of disability following the termination of employment. In such a case the claimant would likely not succeed in establishing their claim for disability.

Comments (28)

  • My husband had a brachial plexus injury that needed emergency surgery in Nov 2021. Since he didn’t qualify for FMLA yet, he didn’t receive any pay, but was still employed. While waiting for a specialist to decide on his succeeding treatment, he availed of supplemental insurance at work during the annual renewal of benefits including a LTD policy from UnUm that he started paying for in March. After his second surgery at the end of March, he was determined to recover within 12 to 18 months with a plan to receive intensive physical therapy and possibly 2 more succeeding surgeries. This is when we decided to file for LTD claim with Unum. His surgeon filled out the medical form but his employer refused to fill out the claim form claiming he is not covered by disability. SS application is still on process. Do we have any chances of getting this LTD filed if his employer won’t cooperate?

    Belle May 7, 2022  #28

  • Sabrina, you will need to speak with an employment attorney regarding any questions related to FMLA. We would need to review the short term disability denial letter in order to assess your rights under same. From what you indicate it seems that the insurance carrier would be willing to re-open the claim if your doctor took you back out? Has anything of the sort occurred since the July 25 release date. Please feel free to contact our office to discuss your STD claim in detail.

    Stephen Jessup Sep 9, 2020  #27

  • I have been employed at a Hospital since 2018. During the Covid Pandemic, my doctor had taken me out of Work due to underlying medical conditions (Chronic Lung Disease) because I was at greater risk for complications if I contracted Covid. I have been out since April 9th. My employer had me on FMLA from April – June and I started receiving Short term Disability checks in May. I was released to work on July 25th with the exception that I could not care for any Covid patients. My employer said they could not accommodate me, so the third party insurance company stopped payments stating my Doctor needs to take me back out of work. Under the Cares Act, am I supposed get 12 weeks of FMLA and is it legal for them to combine my STD and FMLA together? Lastly, shouldn’t they continue my STD because my employer states they can’t accommodate me? I need some clarity to my situation quickly because this is my only source of income.

    Thank You

    Sabrina J. Sep 9, 2020  #26

  • Jack: You would have to file an appeal of the STD denial. Termination of employment while on claim does not typically result in an automatic denial of further benefits but you would have to review your former employer’s self-funded STD Plan to determine your rights. I suggest you contact our office and speak with one of the attorneys to discuss your situation and answer any specific questions you may have regarding your claim.

    Jay Symonds Apr 18, 2020  #25

  • I was on STD and terminated by my employer and benefit payments stopped. I contacted Metlife who approved my payments weekly to inquire about my payments. MetLife told me to contact my former employer regarding payments (employer pays benefits). My employer told me Metlife has the wrong date in there system and I’m no longer eligible for STD because no longer employed. Now, I’m receiving LTD direct from MetLife. Does my former employer owe me for the remaining 21 weeks (I was paid for 5 weeks) of short term disability?

    Jack Apr 18, 2020  #24

  • Update from Jack. I was given a termination date of (September 13th) before I went out on short term disability on August 29th. This was approved by MetLife and paid my employer. I then received a phone call from my company updating my termination date based on MetLife return to work date. I then called MetLife and told them I was still under doctor care and they opened a new claim going back to the original date (August 29) and approved my leave through December 27th. I have yet to receive pay benefits from my former employer. What can I do?

    Jack Dec 9, 2019  #23

  • Jack: It sounds like your employer has a self-funded salary continuation program. If MetLife has overturned its initial denial and approved your claim through 12/27 your employer should pay the benefit. Employment status is relevant as of the date disability began so in your case it would go back to the date you first went out and from which they were originally paying you a benefit. I suggest you contact our office and speak with one of the attorneys to discuss your options.

    Jay Symonds Dec 8, 2019  #22

  • I was out of work on short term disability and my employer sent a letter terminating my employment based on the MetLife approve return to work date. Not my doctors date which was two weeks later. I have since received a revised approval date through 12/27. However, my former employer refuses to pay me the STD benefits. They are telling me I’m no longer an employee? My disability began when I was employed? What’s my options at this time?

    Jack Dec 8, 2019  #21

  • Bill, you would need to request and carefully review your disability policy in order to determine whether your benefits will be terminated if you accept the position. Most policies will terminate your benefits if you return to work, even in a different position, and you do not have a loss of income in the new position.

    Cesar Gavidia Nov 11, 2019  #20

  • I am currently on LTD after a serious shoulder surgery. My other shoulder is also injured and requires an even more serious surgery that will likely leave me permanently disabled. I was a Field Engineer and can no longer do that job but the Company has allowed me to apply for a position on the phones with similar pay. If I accept this position and go off of LTD, can they then terminate me? If so, would I be better suited to remain on LTD?

    Bill W. Nov 11, 2019  #19

  • S. Price, I am sorry to hear of all the pain that you are going through. While there is no way to guarantee a claim’s approval, it certainly sounds like you would have restrictions and limitations preventing you from performing all the material duties of your own occupation. The key is Proof. Proof is in the form of medical documentation and support from your treating physicians. Please contact us at your convenience so that we can discuss your potential claim.

    Alex Palamara Nov 9, 2019  #18

  • I’ve worked for same company for 34 years. Faced paced accounting repetitive work. I’ve had 4 shoulder surgeries, corporal tunnel surgery in both wrist and left elbow. I have chronic neck pain and recieve injections every 3 months. I am in constant pain. I pay for LTD. Do you think I’m qualified?

    S. Price Nov 9, 2019  #17

  • Hollie, in order to be eligible for long-term disability benefits you must satisfy the “elimination period’, which is the period of time that you must be “totally disabled” under the terms of your policy before you receive benefits. If you have any additional questions please contact our office and for a free consultation with one of our disability insurance attorneys.

    Cesar Gavidia Aug 21, 2019  #16

  • Fmla ran out. No short term coverage but I had long term coverage. Now long term said I’m not eligible because I wasn’t off work for a consecutive 90 days. I’m about to be fired and the doctors still don’t even know what’s wrong. I’ve have 10 different intractable or chronic diagnoses within the Fmla leave time. What can I do??

    Hollie Aug 21, 2019  #15

  • Michael, you can try to file, however there is usually a notice requirement in the policy that requires you to give their insurance company notice within 30 days of your disability. But sometime they will make an exception if you were not capable of giving them notice.

    Rachel Alters Aug 12, 2019  #14

  • Could o file a claim for LTD after I had left the job 2 years past? I have since been found totally disabled by SSD. However, my last day of work was 6/16/2017 and that is the date that SSD used to begin my SSD benefits. While at work for three years at this employer found out during my last year I had prostate cancer. Shortly after the diagnosis, perhaps two or three months later I went to HR to discuss filing for LTD. I filled out the application but never filed and then left on my own.

    However, the last year there the company was trying to sell and placed me, who was a supervisor, in non stop turmoil. The stress between the cancer and the job trying for some of out was so great that I left and took early SS, but filed and received SSD.

    Thank you.

    Michael Aug 12, 2019  #13

  • Careb, if your husband was covered under the long term disability plan as of his date of disability, the his rights under the LTD policy would be “time stamped” as of the date his short term disability began. Meaning that even if his employment is terminated he would still have coverage under the long term disability plan due to the fact that he was a covered employee as of the date his disability began.

    Stephen Jessup Feb 15, 2019  #12

  • My husband is on short term disability right now and his fmla just ran out. It seems like his employer is trying to push him out and he has std through April. So if they fire him would it still be possible and raises to get long term disability since he is still on short term disabilith.

    Careb Feb 15, 2019  #11

  • Emma, if your husband stopped working in 2013 the time in which he had to provide the disability insurance with notice of his claim (typically 1 year) may have expired. You may contact our office to discuss what options if any he may have.

    Cesar Gavidia Jan 14, 2019  #10

  • My husband was employed for the same company for 25 years as Computer Technition. He was diagnosed with MS in 1993 and was offered a Helpdesk Position with the same company working from home. In 2012 he had an emergency triple heart bypass and was on short term disability for a few weeks an then returned to work. While working from home in his office setting, it gave him purpose and reason to get up daily.

    In January 2013 his employer called him and told him his position was no longer needed and benefits would end midnight that night. With his physical disability and now a heart condition, there was no way he would be able to even think of applying for another job much less be considered. He applied for Social Security disability the next day and received approval within 3 weeks of applying. He received severance pay for 6 months from his employer and then he started receiving his Social Security benefits right after.

    We are so very grateful that he never missed being paid during that time. For 25 years that he was employed he paid for long term disability. We were told by a couple of lawyers that he would not be able to file for long term disability with his employer since being terminated. I can’t help but think that this just doesn’t seem right or fair. Can you please help?

    Emma H. Jan 13, 2019  #9

  • Brenda, I am sorry to hear all that you are going through and our thoughts are with you. I am happy to hear that your LTD claim is being paid. Regarding your employment status, I don’t have an expertise in employment law issues, however I believe the FMLA laws will govern your claim. There may be nothing protecting your employment status. However, your LTD benefits will continue even if your employment has been terminated. Should you wish to discuss this or your disability claim, please do not hesitate to contact us.

    Alex Palamara Jan 11, 2019  #8

  • I worked for my employer for six years and last year, February 1, I became sick on the job and have not worked since then. I was dx with cancer and had chemo and radiation which ended in August. Awaiting my third MRI which if clear will put me in remission. I am receiving long term disability from my employer who sent me an email stating that I must return to work this month by the 14 or my employment will be terminated. My long term disability is good until 2020. Can they do this to me?

    Brenda M. Jan 10, 2019  #7

  • Kurtis, I am sorry to hear of your difficulties. Typically, if you were covered under the policy at the time you became disabled you can certainly still file a claim. Please contact us and we will gladly speak with you so that we can learn more and hopefully assist you with your claim.

    Alex Palamara Oct 12, 2018  #6

  • I was disabled to work and I couldn’t pay for my health insurance anymore and my long term disability was cancel before I could file my claim. Can I still file a claim? Had to wait on the grease time. What can I do?

    Kurtis N. Oct 11, 2018  #5

  • Monica, so long as you were covered under the LTD policy at the time of your disability, you will be able to apply for the LTD through the Policy and there should be no issue with coverage. Your termination should thus not be an issue. If you have any additional questions or would like a free consultation, do not hesitate to contact us.

    Alex Palamara Feb 21, 2018  #4

  • I am currently on state funded short term disability. If I am still disabled after 90 days I can apply for long term disability through my employer. If I am terminated before the 90 days will I be able to still apply for the LTD through my employer?

    Monica N. Feb 21, 2018  #3

  • Troy, you can certainly reach out to Hartford to try to secure any owed benefits. However, if you failed to appeal the denial of the short term disability claim they may have a legal basis to not consider any information you provide to them. Please feel free to contact our office to discuss your situation further.

    Stephen Jessup Aug 15, 2017  #2

  • I worked for an employer with Hartford Group Insurance Plan I went out on FMLA for about a month. I was fired a few days before I was supposed to return to work. I filed for short-term disability and did a lot of leg work and phone calls to prove my claim. I was in a very high pain level and stress was added by Hartford daily, they made financial situation unbearable and medical issues were many and chronic. I was denied unemployment due to medical issues. I was so stressed out and confused I didn’t want to even deal with Hartford’s low life tactics. After I became homeless the VA and HUD helped me with an apartment and I received a check for around $1000.00. Strangely this was the same month I received my first SSDI check. I never filed for long-term disability due to the fact they never even paid on my short-term disability and it took time for a diagnosis from doctors. My private sector doctors and the hospitals never diagnosed me correctly and even did things that were I believe against my health concerns. After being fired I lost my health insurance so I had to rely on the VA doctors and hospitals. This took even time of a year and more and finally started getting proper testing and diagnosis. I applied for SSDI with no attorney and I was approved. I was in terrible pain constant and chronic and I still am but at least I am dealing with it better. I do believe Hartford still owes me back pay on my disabilities. I did pay them for close to ten years before I had to file and they only made everything worse.

    Troy Aug 12, 2017  #1

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