It is common practice for insurance companies to find ways to limit the amount of money they have to pay to claimants. If you are receiving long-term disability benefits from a policy governed by ERISA, you have most likely been required to also file for Social Security Disability Income benefits. Insurance companies write this requirement into their policies so they can reap the benefits of any past money awarded to you by SSDI as well as reduce the amount of monthly benefit the insurance company is required to pay you. One frequently asked question is:
Whether the insurance company is permitted to not only take a offset for the SSDI benefits received by the disabled insured, but whether it is also permitted to take a offset for benefits the insured’s dependents are receiving (DSSD) as a result of the insured’s disability?
According to a New York Court in the case of Brutvan v. Cigna Life Insurance Company of New York, depending on the specific language in your policy, the answer to that question may be “No.”
Cigna’s Position that Offset is Proper
In Brutvan, Cigna argued that its Plan provides for an offset of DSSD benefits received for the Plaintiffs minor children as well as it does for the Plaintiff. Specifically, Cigna argued that the Plan clearly states that Cigna may offset “Social Security disability benefits the Employee or any third party receives… on the Employee’s behalf.”
Since the Plaintiff’s daughter receives the DSSD benefits only because her father was found to be disabled by the Social Security Administration, Cigna claimed it would also be entitled to take an offset for those benefits. Furthermore, Cigna argued another reason it was entitled to the offset is that the Plaintiff signed a reimbursement agreement obligating the Plaintiff to reimburse Cigna for any benefits received by his dependents.
New York Court Says No Setoff for DSSD Benefits
The Court in Brutvan held, as a matter of law, the Plan language at issue manifests a plain and unambiguous intent to provide LTD benefits without offsets for DSSD. The Plan specifically states that a offset may be taken for SSDI benefits the Employee or any third party receives… on the Employee’s behalf. The Court refused to look outside the Plan for evidence of intent of Plan terms, stating that “if Cigna had intended for DSSD benefits to be offset against LTD benefits it could have made specific reference to “family, spouse, children or dependents in the Plan,” however, it did not.
This ruling is a definite windfall for policyholders who have ambiguous policy language regarding what the insurance company is permitted to take as a offset. This case is an example of why it’s important to read your policy carefully prior to agreeing to allow your insurance company to improperly take an offset of your monthly benefits. If you have questions or concerns regarding your disability benefits and would like to speak with one of our experienced attorneys, please feel free to contact Dell & Schaefer.