disability issue

[NMDisabled]

What is the name of your state (only U.S. law)? New Mexico

My boyfriend worked for his employer for 9 years prior to leaving on short term disability in July 2009. He is about to end his 1 year of short term disability at 70% of his pay.

He has been approved for Social Security Disability. He has also been approved for Long Term Disability by the disability carrier. Here is the issue however: he has been told by his employer that he should get 70% of his pay between SSD and disability carrier as long as the carrier does not have to contribute more than 50% of his previous salary. He has since been told by the disability carrier that his benefit is 50% total between SSD and the benefit.

He has numerous emails from the benefits office stating that he should be at 70%. Does that count as documentation? Does he have any recourse if he ends up getting 50% instead of the 70% he was promised? The 20% difference is a significant amount of money.

 

[swalsh411]

What do the actual insurance plan documents say?

 

[NMDisabled]

I just looked it up for him. It shows the Benefit Percentage is the lesser of:
50% of your monthly rate of basic earnings
or
70% of your monthly rate of basic earnings less other income benefits.

Maximum amount is $10k
Minimum is $100.

 

[cbg]

I'm quite sure that if you look, you will find documentation that LTD benefits can and will be offset by any payments by Social Security. That is quite common (to the point of being remarkable when it does not happen) and quite legal.

If he is looking to receive the full benefit LTD benefit AND the full SSDI benefit, I think he needs to adjust his expectations. He is NOT going to receive more than the overall benefit, regardless of who is paying what.

 

[NMDisabled]

we figured it out. The carrier made a mistake. It is supposed to take the lesser of 2 amounts; 50% of his salary if carrier alone or 70% minus social security if both. They did 50% minus social security instead of 70%. We are going to call them on Monday when they are open and talk to them. Thank you all again.

Math in case you are dense

salary b4 injury 100
Social security award 30

50% of salary = 50
70% - SSD = 40

The carrier would then pay the 40.

They did 50 - SSD = 20

 

[cbg]

If you think you're EVER getting another question answered from me after that, you can think again.