An Illinois District Court held that Lincoln National Life Insurance Company used the wrong date of disability for a Chicago tax attorney to pay him a smaller monthly benefit under the insurance contract.
Ten Pas was a lead partner at the Chicago office of a national tax and consulting firm. Lincoln issued a group long-term disability policy to his employer in the event its workers became disabled. Ten Pans worked a full work week through Friday August 29, 2014. He then worked the weekend - part of the day on Saturday and Sunday - before traveling to his summer cabin in Wisconsin for the Labor Day weekend in 2014. While at his cabin, Ten Pas suffered chest pains and was taken to the hospital and was immediately admitted into the ICU.
That Monday, September 1, 2014, Ten Pas underwent cardiac angioplasty. Physicians released Ten Pas from the hospital the next day with several diagnoses including that of a heart attack. Ten Pas returned to work that Wednesday and went home the same afternoon due to numbness. Later the same day he was admitted to the hospital and remained there for two days. Physicians diagnosed him with a stroke and released him on a Friday. The very next day, Ten Pans returned again to the hospital for six days and was then transferred to a rehabilitation center. He remained in rehabilitation for eight more days until October 20, 2014.
Ten Pas’ Disability Claim
Ten Pas submitted his long-term disability claim for benefits, in which he notified Lincoln that his last day of work was September 5, 2014. His employer also provided information to Lincoln including that his last day work was September 5, 2014. One Physician Statement provided with Ten Pas’ claim indicated that he was recommended to stop working in August when his symptoms began to appear. Another Physician Statement noted Ten Pas’ symptoms began on September 2, 2014 and that was when he could not work any more. When Lincoln asked Ten Pas’ employer for documentation regarding his work the first week of September, it noted he worked in the office on September 3rd and remotely from the hospital on the 4th and 5th.
The last day of work is significant in this case because effective September 1, 2014, Ten Pans bi-weekly pay increased to $15,000. In August 2014, his bi-weekly pay was $12,500. The disability benefit Lincoln had to pay Ten Pas is a percentage of his earnings prior to becoming disabled.
Lincoln’s Policy Language
According to Lincoln’s disability insurance policy, a person’s date of disability is defined as the last day worked just prior to the day disability begins. Lincoln’s policy also stated that unless the person was disabled on the previous workday or on the day he or she was absent, the person is considered actively at work on a:
- Saturday, Sunday, or holiday that is not a scheduled workday;
- Paid vacation day or other scheduled or un-scheduled non-workday; or
- Non-medical leave of absence of 12 weeks or less, whether taken with the employer’s prior approval or on an emergency basis.
Lincoln approved Ten Pas’ long-term disability claim, but used August 31, 2014 as his date of disability. Lincoln notified him that it would continue investigating the “conflicting information” regarding his last day of work. It ultimately determined Ten Pas was entitled to disability benefits based on the lower biweekly salary as of August, 2014.Ten Pas appealed Lincoln’s benefit decision, which it rejected claiming that although he may have worked remotely he never was never actively at work after August. Ten Pas again appealed Lincoln’s decision, which it again rejected.
The court held that Lincoln’s interpretation of the policy language was unreasonable. Because Saturday, Sunday, and the Monday Labor Day holiday were not considered work days the policy language made Ten Pas actively at work through Tuesday, September 2, 2014. Consequently, the monthly benefit amount he was entitled to was based on his higher bi-weekly salary of $15,000.
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