Having to live with chronic pain as result of a work related injury can, at best, make life difficult for a person. Living with chronic pain that renders a person completely and totally disabled along with the added emotional and mental stress of trying to make a claim for short-term and long-term disability benefits can be a nightmare. Such is the case with JoAnn Alexander, a former Met life agency director, whom became disabled on August 31, 2006 due to chronic shoulder pain as result of spinal stenosis, osteoarthritis, fibromyalgia, and cervical radiculopathy. Ms. Alexander terminated her employment with MetLife on March 22, 2007. Shortly thereafter, she applied for short-term disability benefits in accordance with the plan she had while she was working for MetLife.
MetLife originally approved Ms. Alexander’s claim for short-term disability benefits for the time period of March 23, 2007 to June 27, 2007. Inexplicably, MetLife withdrew Ms. Alexander’s first claim for short-term disability benefits on July 11, 2007. Naturally, Ms. Alexander appealed MetLife’s denial.
MetLife answered Ms. Alexander’s appeal on September 6, 2007 stating they would uphold their decision to withdraw Ms. Alexander’s first claim for short-term disability benefits based on the opinions of a non-examining medical consultant. However, MetLife would later approve Ms. Alexander’s second claim for short-term disability benefits on January 2, 2008 due to the surgical repair of a ventral hernia. As a consequence of the surgery, Ms. Alexander received short-term disability benefits in December 21, 2007 through February 1, 2008.
Even though Ms. Alexander’s condition had not improved, MetLife decided to cease paying Ms. Alexander short-term benefits after February 1, 2008. Ms. Alexander went on to appeal both instances in which disability benefits were terminated and sought long-term disability benefits from MetLife. Ms. Alexander submitted further medical evidence to substantiate her continuing disabling conditions that keep her completely and totally disabled.
Following Ms. Alexander’s appeal, MetLife allegedly reinstated Ms. Alexander’s second short term disability claim and paid her $37,585 for the time she was disabled between February 2, 2008 and June 19, 2008. However, Neither Ms. Alexander nor her Illinois disability lawyer received the money from MetLIfe and MetLife asserted that they will not reissue payment.
MetLife also reached a decision on Ms. Alexander’s claim for long-term disability insurance benefits. MetLife explained to Ms. Alexander on April 5, 2010 that she was ineligible to receive long-term disability benefits because she was not an active employee, a requirement spelled out in the insurance plan. Never mind the fact that Ms. Alexander was on an approved leave of absence from the date she filed the claim — October 2, 2007.
To add insult to injury, MetLife came to the conclusion they made an error regarding Ms. Alexander’s second claim for short-term disability benefits for the same reason they denied her long-term disability benefits – because she was not an active employee at the time when the claim was made. Almost all group disability insurance plans require a disability claimant to be actively employed at the time they become disabled. If a claimant is not employed at the time they become disabled, then they are usually not entitled to benefits.
During that time, Ms. Alexander applied for and was awarded Social Security disability benefits. She sought the opinion of two other long-term disability insurance companies – Prudential and American General Life and Accident. Both companies opined that Ms. Alexander was disabled as of March 2007.
Ms. Alexander presented those findings to MetLife. MetLife, however, was not dissuaded. They remained steadfast in refusing to pay Ms. Alexander her short-term and long-term disability benefits. Again, MetLife made the assertion that Ms. Alexander was not an active employee at the time of making her claim.
Since Ms. Alexander had exhausted all for administrative appeals with MetLife, she had no choice but to file an ERISA lawsuit with the assistance of her Illinois disability attorney against her former employer, MetLife, for refusing to pay short-term and long-term disability benefits even though she met the definition of being disabled according to her short-term and long-term disability insurance plans.