Working while disabled does not mean you are not disabled. There are a number of reasons why someone may continue working even though they are disabled.
In a recent ruling out of Arizona, the court ruled in favor of the Plaintiff, Eduardo Nieves, ordering Prudential to pay Mr. Nieves short-term and long-term disability benefits.
Mr. Nieves first attempted to file a disability claim when he learned his employer would be laying off a large number of employees. He informed his superiors that he would be going out on disability and informed his Human Resources Director that he wanted to apply for disability; however, no claim was filed. Mr. Nieves was then laid off from his position on March 10, 2015. In April 2015, he filed his claim for benefits.
Prudential denied Mr. Nieves claim for benefits, stating that Mr. Nieves lost coverage when he was laid off on March 10, 2015. Prudential claimed Mr. Nieves’s disability began on March 11, 2015 – one day after his coverage ended, thus making him ineligible for benefits.
The court found that Prudential’s determination that Mr. Nieves became disabled on March 11, 2015 was based on no evidence other than letters and documents it had produced itself. Also, Prudential ignored evidence that Mr. Nieves had attempted to submit a claim before his March 10, 2015 termination date, but had been rejected and misled by his employer. Therefore, the court found that Mr. Nieves’s claim arose before he was laid off. As a result, Prudential could not deny his claim due to a lack of coverage.
In court, Prudential attempted to make an additional argument – that Mr. Nieves was not disabled. Prudential claimed that the fact that Mr. Nieves continued working until March 10, 2015 proved he was not disabled until March 11, 2015. The court made two crucial points in response to this argument.
First, a person can be disabled even while continuing to work. Working while disabled is not a sign a person is not disabled. The court recognized that people often continue to try to work despite clear evidence from their doctors that the person is totally disabled. As the court noted, people should not be penalized for “the courage and determination to continue working despite [a] disabling condition.”
Second, Prudential cannot make an argument for the first time in court. The law ensures that each person claiming disability be given a full and fair review. This means that Mr. Nieves must have been given an opportunity to respond and defend himself from Prudential’s claims that he was not disabled. Because Prudential never brought up the working while disabled argument before the lawsuit was filed, Mr. Nieves never had that opportunity.
In the end, the court sided with Mr. Nieves and ordered Prudential to pay him his overdue short term and long term disability benefits.