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Long Term Disability Company On Handling of Social Security Family Benefit

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I have long term disability through my company as well as Social Security Disability. My daughter qualified through me as a Family Supplmental Benefit until she turned 18. We managed to get it extended until she graduated from high school. My company plan subtracted my Social Security and hers from their benefit that was payable to me as an offset. No where in the policy does it address what to do when the family benefit goes away. I notified the disability company when the family benefit ended. Several months later, I noticed on my monthly EOB that they 'quietly' reduced my total benefit by the amount that was paid to my daughter yet they did not increase my payout. So it is a numbers game at this point. I have found on the internet the same situation and the lawyer advised that person that they were entitled to that part of their benefit to be reinstated again. I sent a certified letter to the company recently asking for either an explanation or the back benefit and for it to be reinstated. It has been ignored. My questions are: Am I entitled to that benefit and the back wages? What should I do now if I am? Hire a lawyer? This is a big name insurance company and I worked for a large company. Should I contact others that I feel sure have been done the same way to initiate a class action suit for them also?

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You may want to read the policy again, word for word, to make sure you think that what they are doing is inconsistent with the policy language, but other than that, hire a lawyer.

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Thank you for your response. I do appreciate you taking the time to do so. I have reread the policy many times now and there is absolutely nothing that addresses this issue. I actually have issues with the Family Supplemental Benefit being taken against my monthly benefit in the first place as it has very strict guidelines under Social Security rules as to how it can be spent only on that child and not anyone else in the family so why and how it is used against my benefit I don't agree with. Plus, we filed taxes on our daughter only for those benefits and not me at tax time so why those benefits were taken out against me seems to me to be wrong but that's another fight for another day. The only thing that the plan does address/show is how they arrive at the initial calculation in your monthly benefit by simply subtracting your Social Security benefits which include yours and any Family Supplemental Benefits. It is a simple subtraction from your monthly benefit from them. However, it is mandatory that you apply for Social Security Disability. But nowhere does it address what they do when the child(ren) turn 18 and you are still on LTD. The certified letter that I sent to them asked for an official explanation by them in how they handle this situation/issue first off and I noted to them that the issue does not seem to be addressed in their policy/plan. I gave them a reasonable time frame to respond back and it has expired with no form of contact back from them. That tells me that they don't like what I found. This situation occurred starting in 6/18 and it is now up to over $10,000 that they have potentially shorted me now. I talked with my lawyer initially and we agreed to start with a certified letter from me to see what they would do first. I was hoping it would give me some answers at least but evidently the insurance company has decided not to respond for whatever reason. Looks like I will be hiring my lawyer to contact them next as you suggest. I will keep you posted as to what happens next. Would it be a good idea to reach out to other LTD people who may be in the same situation at my company and see what they have to say?

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LAHartline, you need to review carefully the portion of the plan and SPD that deals with benefit claims and follow all of the rules there re the claim, appeals, statute of limitations if denied, ability to go to federal court if denied, arbitration, etc. You need a lawyer where you live who can help you.

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I have checked and the copy of the plan that I am referencing/reviewing says that it is the official SPD. With the disability company ignoring my certified letter, I agree that it is time to get my lawyer involved. Thank you for your advice.

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Mr. Bailey, questions for you. I'm alittle confused on the document plan wording: Is the SPD that the the company has online for viewing the same as the policy/plan that I would need to request a copy of or is there a more in depth official type of document that I need to get a copy of? What is the name of the document that I would need to request a copy of that would possibly have more detailed information relevant to my situation? And if there is, do I need to request the copy from the company that I worked for or the actual LTD company that is handling my disability claim through the company? Thank you in advance for your answers.

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LAHartline, the SPD is the place to start. It should have a section that says whether it is also the official "plan document," or whether the "plan document" is separate. Most likely, for LTD, the benefit is fully insured, so that the "plan document" will be entirely or mostly the underlying group LTD policy. If that is the case, you should be able to get a copy from your employer, but they will likely get it from the insurance company.

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Well I sent two certified letters. One to my employer's benefit plans requesting the plan documents and SPD. They responded back with the Plan Document but it has nothing in it about the Long Term Disability policy. To be blunt, it is ran by MetLife. I did send MetLife a certified letter also with the official documentation from Social Security that shows where my daughter's family benefit ceased to be payable and I requested that my monthly LTD benefit not be offset by it from the cessation date forward. I have heard nothing. Should I have requested the Plan Document from MetLife in my certified letter since they are over the LTD and go from there, should I call Metlife and just ask my caseworker to explain how they handle the offset once the dependent turns 18 or should I get my lawyer involved at this point?

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LAHartline, you have a right to see an SPD that for the LTD. It may be included in an SPD that covers other benefits, such as life and health, if they are combined in a single plan. Beyond that, you may need to hire a lawyer or some other sort of representative (e.g., disability advocate?) who understands the system to help you.

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Agreed. I'm not getting anywhere very fast in my situation. I'm very frustrated since my certified letters especially to MetLife are being ignored. The only SPD I've seen is the one online that is posted on the company's website. But it has nothing that addresses when the dependent turns 18 and what they do about the Social Security Dependent offset. I've been doing research and lawyers on the internet are answering the same question that I have with the statement that they are entitled to the back benefit once their child turned 18. Another one states that my employer is responsible for providing me with a copy of the policy per Section 1332 of ERISA and that failure to provide same could result in civil penalties. Maybe I should state that in a certified letter to my employer requesting it again. Another one states that I needed to request in writing from MetLife an explanation of my monthly disability benefits. I do like that option. It's possible that the company requested the SPD/Plan Document from Metlife and it is having to come from there.  I may need to be just a little more patient a while longer before I do anything else. I need to make some decisions here for sure. If I don't get an SPD or Plan Document soon, I think i will contact my lawyer. It's time. What is a disability advocate BTW?

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12 hours ago, LAHartline said:

What is a disability advocate BTW?

I think that in some states there are nonprofits that advocate for folks with disabilities, but not sure.

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Mr. Bailey, I feel like I'm between a rock and a hard place so to speak. I decided to call MetLife yesterday. My company sent everything but what I asked for specifically. MetLife called me back/my caseworker specifically today. She said that they would not pay when my daughter turned 18 with no further explanation. Yet, I am seeing case after case being answered on the internet by lawyers where especially with MetLife or any LTD company that offsets for that, when the dependent turns 18, the offset is added back into the monthly benefit. I think I will ask again in another certified letter for it and quote noncompliance will result in fines per ERISA and see what happens. And tell them that they sent everything but what I requested. Something is just not right here. A gut feeling I guess. Maybe I'm in over my head and it is time to involve the lawyer since I can't get what I am requesting from them.

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Got some good news today. Benefit Plans from my former work company called me. A very nice person after talking to me is going to send me the Plan Document on LTD that I need. He even asked me what my question was and tried to look up an answer for me in it. However, he was unable to find anything that addressed it. He offered to call MetLife and see what they say. I told him that my caseworker said that MetLife would not be removing the offset and increasing my monthly benefit by the offset. But he was going to call them and see what he could do especially when I told him that I found cases against Metlife where the advice was that they were obligated to pay the offset. Hopefully I won't have to get my lawyer involved. I will update here when I hear back from him.

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Yeah to those who work in benefits!

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