Employees in Chicago with claims for long-term disability benefits most often have been approved for short-term disability benefits first. These two plans nearly always integrate such that the duration of short-term disability benefits equals the amount of time you must be disabled before receiving long-term disability benefits, known as the elimination period. Most long-term disability policies state you must be “continuously disabled” through the elimination period to be eligible for long-term disability benefits. One would think that by receiving the full duration of short-term disability benefits, you have satisfied that standard, but not necessarily so. A recent case demonstrated how not being continuously disabled through the elimination period can jeopardize long-term disability benefits.
In Tranbarger v. Lincoln Life & Annuity Co. of New York, No. 22-3369, 2003 WL 3527418 (6th Cir. May 18, 2023), Tranbarger had an operation to remove her gallbladder. Afterwards, she began suffering from chronic pain and fatigue. She attempted to continue working, but her condition worsened to the point she could no longer work. Her condition waxed and waned such that she could not consistently work, and received short-term disability benefits. When her claim transitioned to long-term disability, Lincoln Life denied her long-term disability claim contending Tranbarger was not continuously disabled through the elimination period. After unsuccessfully appealing, Tranbarger sued under ERISA § 502(a).
On de novo review, Tranbarger lost in the district court. The United States Court of Appeals for the Sixth Circuit affirmed the district court ruling against Tranbarger. The court held Tranbarger was not continuously disabled through the elimination period. The court reasoned “[t]he bar set by the plan’s requirement of ‘continuous’ disability, it bears mentioning, is a high one. Even one day of partial work ability during the Elimination Period is enough to defeat Transbarger’s claim.” The court explained the medical records demonstrated that Transbarger’s pain and fatigue levels fluctuated on any given day, as did her work capabilities. This demonstrated Tranbarger could perform some work functions on some days during the elimination period, thus defeating her claim for long-term disability benefits.
If you have a claim for long-term disability benefits, contact a knowledgeable ERISA long-term disability attorney today.