Like the Seinfeld or Superman Bizarro World, sometimes good news is bad news and vice versa. For example, the big rise in today’s stock market was attributed to worsening economic news. Moreover, MetLife approved a disability income policy application today for one of my client’s; however, counterintuitively, the approval may not be good news.
MetLife has agreed to pay my client benefits under the policy through December 23, 2015. When a disability policy application is approved, the insurer usually pays through the date of the current monthly period. MetLife neglected to say what happens as of December 24, 2015.
Does MetLife’s ambiguous letter mean that it found the claimant is disabled, and will re-evaluate updated evidence in a couple of months? MetLife’s ambiguous letter could just as easily mean that it found the claimant will no longer be disabled as of December 24, 2015. As noted above, since insurers usually only pay benefits through the date of the approval, it appears that the more pessimistic alternative is likely.
Rather than taking the wait and see approach, I have demanded that MetLife clarify the ambiguity. Because this application was under an individual disability policy, ERISA does not apply. Therefore, the claimant does not need to waste his time appealing the December 24, 2015 decision with MetLife, and can immediately file a complaint in State court.