We represent many FCPS teachers who have been denied short term and/or long term disability benefits, and we have been appalled by how they are treated – both by FCPS and by their disability insurance company, Liberty Mutual. Most group disability policies are governed by a federal law known as ERISA. There are some good things and some bad things about ERISA, but since FCPS is a government entity, their disability plan is NOT governed by ERISA. Great, you might think – this means they can keep what is good about ERISA and fix what is bad. Ha ha, no. In our experience, the FCPS disability plan keeps the bad and tosses the good, and the result can be disastrous for teachers.
The first place the FCPS plan goes terribly wrong is in how long teachers have to file an appeal if their short term disability benefits are denied. ERISA (and almost every other disability policy we have EVER reviewed) gives claimants 180 days from the day they receive the notification that their benefits are denied. That gives them time to process the denial, time to talk with their doctors, time to request their claim file to see what happened, and time at any stage to find an experienced disability insurance lawyer…all before actually writing and submitting their appeal. FCPS teachers have 60 days to do all this – FROM THE DATE ON THE LETTER, not from the date they received the letter. (Delay in the Liberty Mutual mailroom? Letter sent Friday before a holiday weekend? Tough luck for you. Liberty will not budge on the deadline.)
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Even in ERISA cases, it is not uncommon for us to ask for an extension for our clients (sometimes getting additional testing or medical records just takes longer than we expected), and the answer is always “yes.” This is not because insurance companies are nice and understanding – it’s because they know that ERISA requires them to be “reasonable” and to act in the best interest of claimants. The Fairfax County school teachers’ disability program has no such restrictions, but you’d think they would want to help their teachers anyway, right? No – twice recently our teachers have asked for extensions (60 days is just too short when you are disabled to do everything you MUST do to file a successful appeal!). The answer from FCPS: NO. No extension, not even for a week. Not even because you just found a lawyer and your lawyer said this appeal is complicated. Just, “no.”
The problems continue even after your claim is approved. All insurance companies require medical updates, understandably. Most will request updated information from your doctors and will let you know if they don’t get the information, giving you several notices and tries to get your doctor to send the information. But I am writing this particular post this particular week because just recently, we won an appeal for an FCPS teacher who has a serious, degenerative, neurological disease. This disease does not get better, and is well-documented in her records.
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Just a few months later, Liberty Mutual notified us that they needed updated medical information, which they had requested from her doctor. One month after that, Liberty Mutual wrote again to tell us that 1) they had not received the information (normally our cue to spring into action to work with the doctor’s office to figure out why not) and 2) HER BENEFITS HAD BEEN SUSPENDED – AS OF TWO WEEKS EARLIER! It gets better – when we called the records provider for the doctor’s office, they said they had received the initial records request, and had promptly sent Liberty Mutual an invoice for the records (which is standard practice). Liberty Mutual had not paid the invoice, which is why they had not received the records. Liberty Mutual makes the mistake, our client suffers. And the people at FCPS who could fix this do not seem to care.
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That’s a strong statement, isn’t it? “FCPS doesn’t care.” Well, blogging about this kind of treatment is not our first response. We have documented numerous times when our clients have been treated like this, and have communicated with FCPS…first, by calling and emailing the Human Resources department. Then, by copying the FCPS Human Resources department and the FCPS legal office on some of the correspondence between us and Liberty Mutual, pointing out this aggressive claim handling designed to deny benefits to teachers who are disabled. What have we heard back? Crickets.
And we see the claim handling notes in our clients’ files. We see where Liberty Mutual calls FCPS to see if our teachers can have a short extension to file their appeals. We see where FCPS, who could easily say YES, says NO instead. They know what’s happening to their teachers. It’s just that this news hasn’t yet made its way to someone who actually cares.
We are now filing lawsuits – we have filed two so far and are filing a third this week. The lawsuits go to the Fairfax County School Board, so maybe someone over there will start paying attention. This gets action for our clients, but obviously is no one’s first choice. Lawsuits only cost a cash-strapped county even more taxpayer dollars. There has got to be a better way!
If YOU are someone who cares, or if you know someone in FCPS or on the Fairfax County School Board who cares, please contact us. We happen to be parents of FCPS students – past, present and future. We think teachers are SUPERHEROES and deserve to be treated as such. We’ll give you an earful. And together, maybe we can FIX THIS for all FCPS teachers. Because our teachers should not need to hire a lawyer in order to get the disability benefits they were promised – and deserve – when they need them.
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