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Lucy, Esq.
Lucy, Esq., Lawyer
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I need to ask a question about MetLife LTD insurance that I

Resolved Question:

I need to ask a question about MetLife LTD insurance that I have through Kaiser ( as a Kaiser employee). Anybody out there feels competent to take this question ?
Submitted: 1 year ago.
Category: Consumer Protection Law
Expert:  Lucy, Esq. replied 1 year ago.
Hi,

My name is XXXXX XXXXX I'd be happy to answer your questions today.

The answer here is that it's really up to MetLife. Most likely, their benefit payment department and their billing department are separate, so they won't have that capability. There's nothing in the law that would require them to deduct your premium from your payment. However, if you call and ask, they may have some options for you. They should be able to automatically withdraw your premium from your bank account the day after they deposit the benefit, which would at least take away concerns of being able to make the payments on time.

If you have any questions or concerns about what I've written, please reply so that I may address them. It's important to me that you are 100% satisfied with the service I provide. Otherwise, please rate my service positively so that I get credit for answering your question. Thank you.

Customer: replied 1 year ago.

I am sorry , I obviously was not clear what I was asking. I have a personal,private dis. insurance ( not MetLife) that is paying me a benefit while out on LTD. I also do have MetLife through work paying me a benefit which MetLife normally integrates with STD,pay or Worker' comp. or even Social Security (to pay me 70 % of my income) . My question now is if MetLife is allowed to also deduct/integrate the benefit I receive from my private disability insurance as well from the benefit they are paying me ? I always thought that MetLife is not allowed to use my private dis. insurance for integration , that it is something entirely different then the benefits I receive through work ( I got the private insurance to have a better coverage in case of a disability). I just want to make sure I am right ( because MetLife is integrating with STD, WC or SSI) that I can draw from two benefits without MetLife being able to use my private insurance benefit to integrate ( to just pay me 70% of my pay) ? Thank you for any response.

Expert:  Lucy, Esq. replied 1 year ago.
If the contract allows them to reduce your benefits based on payments received from other areas, then they can do that. If they're saying that they're allowed to send you reduced payments, ask them to email you the contract, highlighting where it says that. If they can't do it, then they can't send you reduced payments.
Customer: replied 1 year ago.

I work for Kaiser, does that make a difference?


The only information in 'my benefits' I could find is that they pay me up to 70 percent of base pay when integrated with other disability benefits ( such as STD, WC, and /or SS). It never mentions any private ,personal insurance in any way.

Expert:  Lucy, Esq. replied 1 year ago.
Who you work for shouldn't have any effect on what they are contractually obligated to provide you.

See if the contract defines "disability benefits" to include or exclude private insurance - that is, check to see if it specifically makes it clear that only public benefits are counted. If it only talks about benefits and doesn't mention insurance, then they can't deduct from what they're sending you. If the contract is ambiguous, it's interpreted against them because they wrote it.
Customer: replied 1 year ago.

I looked at another document I signed where MetLife states that "they are allowed to reduce the benefits payable to me by amounts payable to me from SS, WC, STD , or any other act or law of like intent."


 


Again, they are never mentioning "private insurance" in any way.


 


Is that a clear enough statement in my favor?


 


Thanks

Expert:  Lucy, Esq. replied 1 year ago.
It's not really clear, but you could argue that since the programs mentioned are all benefits required by law, and private insurance is not, your benefits should not be reduced by private insurance. Again, ambiguity is resolved against them. If they wanted to be able to reduce benefits because someone had separate, private insurance, then the contract should say so.
Lucy, Esq., Lawyer
Satisfied Customers: 20222
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Customer: replied 1 year ago.

No more questions, it got resolved. Thank you

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