Employees in Chicago with claims for long-term disability benefits often begin experiencing limitations in their ability to work before stopping work and claiming long-term disability benefits. This raises the question whether the disability begins when you first start experiencing limitations, or when you stop working. Most policies require you be limited from performing the material and substantial duties of the occupation and experience and income loss continuously in order to be disabled, suggesting disability would not be triggered until you stop working. Some policies also state you need not experience the loss in earnings due to the same injury or sickness during the elimination period to qualify for benefits. Figuring out the disability date can require careful construction of these provisions together. The disability date can dramatically affect the amount of long-term disability benefits, especially if you received a pay raise before finally stopping working. A recent case wrestled with these provisions to determine when a claimant qualified for long-term disability benefits.
In Glickman v. First Unum Life Insurance Co., No. 19-cv-5908, 2023 WL 3868519 (S.D.N.Y. June 7, 2023), Dr. Glickman was diagnosed with prostate cancer in early 2016 and had his prostate removed. The surgery left Dr. Glickman with pain, weakness, and fatigue. He continued working for a year, but in December 2017 claimed long-term disability benefits under his employer’s ERISA-governed long-term disability plan insured by First Unum. Unum approved the claim and determined his disability date was November 1, 2017, but later rescinded it and determined the disability date was September 1, 2016, the date of his prostate surgery. The change had a large difference in his long-term disability benefits, as Dr. Glickman’s 2015 earnings were $688,000 and his 2016 earnings were $805,000. Thus whether Dr. Glickman was disabled was not in dispute; just his disability date, and hence the amount of the long-term disability benefit was in dispute. After Dr. Glickman unsuccessfully appealed, he sued under ERISA § 502(a).
The United States District Court for the Southern District of New York ruled in favor of Dr. Glickman, finding his disability date was November 1, 2017. It reasoned that the insurance policy requires one be continuously disabled through the elimination period to be eligible for long-term disability benefits. The policy defines disabled as (1) being unable to perform the material and substantial duties of the occupation, and (2) having a 20% loss in earnings due to the same injury or sickness. First Unum argued that language below that states the insured need not have a 20% loss in earnings due to the same injury or sickness during the elimination period. Employing principles of contract interpretation, the court found that clause only excepts the earnings loss from “the same injury or sickness” during the elimination period, giving effect to as much of the language as possible. The court thus ruled in Dr. Glickman’s favor and awarded the higher disability benefit.
If you have a claim for long-term disability benefits, contact an experienced ERISA long-term disability lawyer today.