Do I Always Have to Repay Social Security Disability Benefits to My Insurer?
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. Dell Disability Lawyers had no involvement in representing Mr. Kapp or in his case.
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Lincoln Financial
Uses every dirty trick in the book
It’s next to impossible to get $ out of them without a lawyer. They use plenty of intimidation and unfair tactics. They don’t want to pay. And yet, their CEO made 13 m... read more >
Unum
Unum is evil
On 11/3/2021 I got shot by my boyfriend and my spinalcord got hit, paralyzing me from the neck down and accepting Unum benefits was the worst decision I ever made. I sued ... read more >
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Every month I get paid on a different date
I will start by saying that my experience is not as horrible as others, like the folks who have valid claims but get nothing from Lincoln. I feel for you and hope to god y... read more >
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MetLife’s handling of my short-term disability claim has been incredibly frustrating and stressful. I followed all the necessary steps prior to my surgery, providing the... read more >
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Sedgwick
Don't trust them, they like to play games
They suck the life out of people that need help. They falsely advertise for helping people that they care. Sorry to tell you it's all about money, they do not care for any... read more >
New York Life
Lyme Disease Disability Claim Denial
I have had repeat claims for genuine medical leave and they have repeatedly been denied by NY Life. I have even been diagnosed with Lyme and going through treatments and t... read more >
New York Life
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I am beyond disappointed with NY Life Disability Insurance’s handling of my father’s claim. My father, a 66-year-old man who has suffered two strokes and continues to ... read more >
New York Life
New York Life is a joke!
This company sucks when it comes to disability claims. They are slow at processing stuff, then they always say they didn't recieve the doctors information. You spend your ... read more >
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Do I always have to repay Social Security disability benefits to my disability insurance company? Maybe not!
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 r... Read More >
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When it comes to securing your disability insurance benefits, it's vitally important that your disability insurance lawyer thoroughly understands the symptoms and impact of your disabling condition. Doctors can help you create strong medical records, but they're not accustomed to dealing with the rigorous documentation disability insurance companies require. Lea... Read More >
Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak
If you're seeking long term disability benefits from an insurance company, you may be concerned that you're facing an uphill battle. Fortunately, the stronger your medical evidence, the greater the odds that your claim will be approved. On the other side of the coin, one of the most common reasons for denial of long term disability benefits involves too-weak med... Read More >
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Showing 8 of 375 Dell Disability Cases
Seven Surgeries and The Standard Still Denies Disability Insurance Benefits
Our client was employed with the State of Oregon as a Technical Support Representative. She sought disability through her employer provider LTD Policy with Standard due to low back, hip, and lower extremity pain. She had two hip, two knee and three back surgeries.After paying her for 1.5 years Standard hired a board-certified neurologist to perform a review ... Read More >
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Prudential reverses decision to terminate LTD benefits of MRI Tech with Primary Progressive Multiple Sclerosis and degenerative Disc Disease
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The claimant is a former Senior Technology Services Engineer for Accolade, Inc. who was forced to cease working on May 25, 2021 and to apply for disability insurance benefits under his policy with Prudential because of severe symptomatology related to depression and anxiety. Prudential initially approved his claim for LTD benefits as his symptoms were demonstrat... Read More >
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5 Ways We Help Get Your Benefits Paid
Get Your Disability Application Approved
Our goal is to get your application for disability insurance benefits approved. Applying for disability insurance benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their hired gun doctor.
Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.
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If your disability insurance benefits have been wrongfully denied, then our disability insurance lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.
Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of disability. We encourage you to contact any of our long-term disability attorneys for a free immediate review of your disability denial.
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We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.
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Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.
Our disability insurance law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.
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Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our disability insurance lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.
Questions About Hiring Us
Who are Dell Disability Lawyers?
We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.
Our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement in more than 98% of our cases. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.
We offer disability insurance attorney representation nationwide and we welcome you to contact any of our LTD lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 900 videos and regularly provide tips to help protect your disability benefits.
Who do you help?
Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.
Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.
A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.
Do you work in my state?
Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability insurance lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.
What are your fees?
Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.
The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.
In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.
Do I have to come to your office to work with your law firm?
No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, or video conferencing sessions. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.
How can I contact you?
When you call us during normal business hours you will immediately speak with a disability insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.