An employee who files for Social Security disability benefits based on the inability to work doesn’t automatically qualify for her company’s ERISA disability benefit plan when her federal benefits come through.
She can be disabled under federal law but still capable of working as defined in the company insurance plan.
Recent case: Tamara worked in benefits for 15 years until she developed fibromyalgia and applied for Social Security disability benefits. She got those benefits but sued when she was turned down for additional payments under her former employer’s disability insurance plan.
The court dismissed her lawsuit. It ruled that just because she qualified for federal benefits didn’t mean she also should receive payments under the company plan. The doctors reviewing her medical records determined she was perfectly capable of doing her old job. They considered Tamara’s testimony that she could walk a mile and carry up to 15 pounds while doing so and concluded she could have done her old job. (Dibartola v. U.S. Steel, No. 12-CV-1812, WD PA, 2013)
Final note: It is also true that someone who has been determined disabled under Social Security standards may still be a qualified applicant or employee under the ADA. That’s because the Social Security Administration doesn’t consider any type of accommodations that an employer might offer when determining eligibility.
Always consider possible accommodations for a disabled applicant or employee, even if he or she has filed for and is receiving Social Security disability benefits.
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