Everyone has heard the expression “You get what you pay for.” Disability insurance policies are contracts and the better the policy language for a disabled claimant; then the more expensive it is going to be to buy. Some employers that buy short term or long term disability insurance policies of their employees may look to spend as little as possible. Unfortunately, employees may be stuck with a disability policy that does not provide the protection that was anticipated.
The case against MetLife, which was not handled by our law firm, is a perfect example of a MetLife disability policy with horrible language. Certainly this claimant’s employer could have purchased a disability policy with better language, but choose not to.
Beware of disability insurance policies that limit the pay period for any condition
Every year thousands of claimants file claims for disability benefits due to the inability to work as a result of neuro-musculoskeletal issues (affecting their cervical and lumbar spine). Some claimants undergo conservative treatments such as injections and medications to attempt alleviate their discomfort. Others undergo high-risk spinal surgeries in an attempt to obtain some relief. Often times, neither remedy alleviates their pain, leaving them to contend with this disabling condition for the duration of their lives.
As a result, most of these individuals are unable to perform even sedentary work as the pain is too distracting, they are unable to sit at a desk for extended periods of time and the medication they take daily has severe side effects such as drowsiness and fatigue. Knowing that they are insured should the day come that they will no longer be able to work is somewhat comforting; however, it may come as a surprise to these claimants that should they become disabled due to a back or neck problem, even if they were to become a quadriplegic, their policy may only pay them for 24 months.
Federal Judge in Georgia holds employer may limit benefits to 24 months for neuro-musculoskeletal disorders with no exceptions
In the case of Bland v. MetLife the Plaintiff was injured in an automobile accident and underwent an L5 laminectomy with discectomy and fusion at L5-S1. She returned to work after her surgery, but fell down the stairs and reinjured her back. She filed for STD and was paid by her employer. She then received long term disability benefits for 24 months, until MetLife informed her that since her disability was due to a neuro-musculoskeletal or soft tissue disorder her benefits were limited to 24 months.
Plaintiff filed a lawsuit alleging that the plan failed to define “neuro-mulsculoskeletal disorder” and also failed to contain exceptions to the 24 month limitation. Most plans that carry this limitation also provide exceptions. Here, the employer modeled their plan after MetLife’s; however, it removed the exceptions which would allow for benefits past 24 months if you could provide objective evidence of radiculopathies, myelopathies, spinal tumors, seropostive arthritis or musculopathieis. Under the MetLife version of the policy, the Plaintiff would surely be able to show objective evidence that would provide her benefits beyond 24 months.
But MetLife agrees that I am disabled
According to the Court in this case, “however unfair it may seem, the Plaintiff cites no law, and the Court has found none that bars her employer from drafting its Plan any way it chooses, so long as it complies with ERISA. The employer is the master of its plan and no ERISA provision bars it from excluding coverage for neuro-musculoskeletal disorders.”
Even though MetLife agrees that the Plaintiff is unable to work as a result of her back condition and objective evidence supports this fact, she is still not eligible for benefits beyond 24 months.