My husband works for a company and is currently receiving short term
disability for post traumatic stress syndrome. ( He had an episode at
work, heart attack like symptoms-was diagnosed with ischemia which was
brought on by his long hours and stressful situation.) If his M.D.
find he cannot return to his job, do we have to pay back his benefits?
It is extremely unlikely that you would have to pay back the benefits.
The benefits are there to compensate him for his loss of income
resulting from being unable to work. Whether or not he can work in
the future typically has no bearing on them.
If his doctor finds him unable to work in his job going forward, and
he has long term disability coverage, then he would apply for that.
The benefit amounts may change, as well as the criteria for
disability. Many policies limit or exclude "mental and nervous
conditions." Social Security Disability income may also come into
play, whether or not your husband has private long term disability
insurance. Many private policies require applications for SSDI.
It would be in your husband's best interest to request a copy of the
policy/certificate and summary plan description from his employer now
so that you know what he is dealing with, assuming this policy was
purchased through or provided by his employer. In most cases, group
policies are governed by ERISA, a federal law. While this is
generally a bad thing for claimants, in this situation it is
beneficial because, upon receipt of his written request, his employer
is obligated by federal law to provide you with these materials free
of charge within 30 days. You should make the request in writing,
return receipt requested so that you have proof that the employer
received the request.
If you think it is at all likely that your husband will not be able to
return to his job, you also need to consider finding legal
representation with experience in dealing with ERISA disability
benefit claims (if ERISA applies to your situation). Particularly in
a case like his, where the condition is believed to be caused by
stress, the insurer will try to make it a mental and nervous condition
so that they don't have to pay benefits or only have to do so for a
short period. A lawyer may be able to help you and his doctor
emphasize the physiological problems, the ischemia, which would not
have benefits limited in the same way. Many disability claims are
irreparably harmed by the initial application for benefits, so the
best time to consult a lawyer is before you fill out all the
paperwork, not after the claim is denied.
A great resource for asking disability insurance questions is
"Disability Insurance Forums"
http://www.disabilityinsuranceforums.com. Look under Disability
Insurance Claims Advice for lots of information on ERISA, transferring
from short term to long term disability, and dealing with symptoms
combining both mental and nervous conditions and a physiological
problem.
Good luck. Obtaining long term benefits can be very difficult, but if
you know what you are doing and work with an experienced attorney, you
can greatly improve your chances.
Sincerely,
Wonko
- I am not a Researcher -
In my opinion the answer is NO, the income replacement does not get paid back.
It would help the Researchers considering your question if you could
provide the jurisdiction, whether your husband paid premiums or the
company provided the coverage, whether the stressor(s) were chronic or
acute, whether the stressor(s) is the nature of the work or the
shaping of the workplace environment by the management's conduct.
I would strongly recommend that your husband also get a copy of the
full contract that describes the terms and limitations of the income
replacement so that you can be informed of its maximum duration and
all the possible outcomes at that end-state.
- I am not a Researcher -
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