Making a Disability Claim as a Meta Employee

Meta is headquartered in California, but has significant offices around the country. There are Meta corporate offices in New York; Seattle; Boston; Chicago; Atlanta; Miami; Washington DC; Denver; Reston, Virginia; Austin, Texas; Pittsburgh, Pennsylvania; and Detroit, Michigan. Meta also has data centers with white collar workers in most states.

For Meta employees, it’s crucial to understand your rights under the Employee Retirement Income Security Act of 1974 (ERISA), especially concerning disability benefits. ERISA provides protections for employees participating in employer-sponsored benefit plans, including the right to appeal denied claims and to file lawsuits for wrongful denial of benefits. Meta employees need to understand that if they can demonstrate they were disabled before their last day of work, they are covered under Meta’s short and long term disability plans even if they have already left Meta or been notified of termination.

Many employees have health issues that are significant enough to qualify as a disability, but push through the pain because they love their career, or need the money, or both. The fact that you worked while disabled does not disqualify you from making a claim now, it simply demonstrates your commitment to working and the effort you exerted to keep your employment as long as you could.

The Meta Short Term Disability Plan

Meta’s short term disability plan is administered by Lincoln Financial Group. Meta pays the benefits for the short term disability, and the short term disability plan is not an ERISA plan.

Under the short term disability plan, employees can receive up to 25 weeks of paid leave after a one-week elimination period. During the first 16 weeks, Meta will pay 100% of an employee’s weekly pay under a short term disability claim. After 16 weeks, the benefits drop to 70% of weekly pay for up to another 9 weeks. If you live in a state that offers paid disability, Meta will require you to apply for that disability benefit from the state, and will deduct the amount paid by the state from what Meta pays you. Coverage begins on your first day of employment and applies to all employees working at least 20 hours a week. Under the short term disability plan, “Disabled” means “the Employee, as a result of Injury or Sickness, 1) becomes unable to perform his or her regular or customary work by reason of any physical or mental illness or injury, including pregnancy, childbirth or related medical conditions; or 2) has been ordered not to work by written order from a state or local health officer because he or she is infected with, or suspected of being infected with, a communicable disease.” The short-term disability plan requires the employe to complete claim forms, an attending physician’s statement, and the “provision by the attending Physician of standard diagnosis, chart notes, lab findings, test results, x-rays and/or other forms of objective medical evidence in support of a claim for benefits.” Meta defines a “physician” as “a licensed practitioner of the healing arts in a category specifically favored under the health coverage laws of the state where the Treatment is received and is practicing within the terms of his or license.” This will include naturopaths and therapists. When calculating the insured’s salary for short term disability for corporate employees, Meta does not include commissions, overtime or bonus income. For data center employees, Meta considers base pay and overtime. The short-term disability plan has an optional, two-level appeal process if an employee’s claim is denied. The employee can also bring suit against Meta for failing to properly pay wages, pursuant to state laws.

The Meta Long Term Disability Plan

Meta’s long term disability plan is insured and administered by Lincoln Financial Group. That means that Lincoln pays the benefits it is reviewing. The long-term disability plan is insured by a policy issued by Lincoln, and is subject to ERISA.

The long term disability plan takes over at 26 weeks. There are two classes of employees under the policy, Class 1 employees who do not elect a tax-free benefit, and Class 2 employees who do choose the tax-free benefit. To qualify for benefits under the long term disability (“LTD”) plan, employees must be able to demonstrate that they were disabled throughout the “elimination period,” which is 180 days, and ties to the 180 days of the short term disability policy. The Plan pays 66.67% of the employee’s basic monthly predisability earnings up to $20,000 per month depending on the insured’s annual salary. As with STD benefits, LTD benefits do not include overtime or bonuses in the calculation of the monthly benefit. Benefits are potentially paid up to age 67. Lincoln can require you to apply for Social Security Disability Insurance benefits and offset them against what it owes you.

If you become disabled in your first year of employment with Meta, your LTD coverage is subject to a pre-existing exclusion. That means that if the insured claims a disability “whether diagnosed or undiagnosed, resulting from an Injury or Sickness for which the Covered Person received Physician’s advice or Treatment within three months prior to the Covered Person’s effective date of coverage” that began in the first twelve months after the employee’s effective date, the coverage is excluded.

For most disabilities, LTD benefits are potentially paid to age 67. For the first 24 months of long term disability, the employee has to prove the inability to perform the material and substantial duties of their “own occupation.” After 24 months the employee must demonstrate the inability to perform the duties of any gainful occupation for which the employee is reasonable fitted by “age, education, training, experience, station in life, and physical and mental capacity.” The “station in life” language generally means that the insured cannot be required to take a low wage job compared to the former salary, but does not create a direct correlation between the insured’s prior wages and any required minimum wage for other occupations.

The long term disability plan includes limitations of 24 months of coverage for any disability related to Mental Health or Substance Abuse.

What do you need to demonstrate disability, especially if you were working full time at the same time you are claiming disability? You need to demonstrate that your treating physician agrees that you had restrictions and limitations that kept you from performing the materials duties of your own occupation as of your last day of work, and you have to have been treating for the symptoms causing those restrictions and limitations as of your last day of work. You need to demonstrate “regular” treatment by a medical professional for the condition that keeps you from working.

Courts understand that many people push through disability and try to work anyway because they love their job, or they need the income, or both and have routinely held that the fact that an employee was working does not bar them from claiming disability at the same time. Employees can also make claims for disabilities that arose after they learned of the termination of their position but before their last day, if they have medical support. That includes depression and anxiety, if an employee is diagnosed with and actively treating for such a condition before their last day of work.

All Meta Employees Nationwide Can and Should Pursue Their ERISA Disability Insurance Claims in California Federal Courts

The Meta long term disability plan is governed by ERISA. Lincoln routinely denies many disability claims, especially those involving mental health or “self-reported” symptoms such as pain, migraines, cognitive issues, or fatigue. Insureds are required under ERISA to appeal a denial, but after one appeal, there is no further option for reconsideration under the long term disability plan. The next step is litigation. Lincoln, like most insurers, is often interested in buying out the value of the insured’s claim, including future benefits, at litigation. This enables some insureds to obtain a lump sum settlement. Lincoln looks at the total claim and the litigation, including the court where the litigation is filed and the judge assigned, when making determinations about settlement.

While under ERISA an insured can technically bring suit anywhere in the US, Lincoln will push back on most suits if there is not a specific connection, arguing successfully that the court should not bear the cost of the litigation without a clear connection. Under ERISA, there are three locations where the insurer cannot dispute the venue of the lawsuit – if it is filed where Lincoln is headquartered, if it is filed where the insured lives, or if it is filed where the disability plan is administered. Meta administers the LTD Plan in the Northern District of California in the Ninth Circuit. This is arguably one of the most favorable districts in the country for disabled plaintiffs.

Many insurers include language in their disability policies that grant them “discretion” in deciding claims. Courts interpret that language to mean that the court must accept the insurer’s decision unless it is clearly “arbitrary and capricious.” The Meta policy does not include this language. While discretionary clauses have been banned in several states, including California, Oregon and Washington, and are not enforceable in those states, courts in other states that do not have such a ban are used to deciding cases under the arbitrary and capricious standard. Those judges may have a hard time changing that mindset even when the policy language does not require it. Courts on the west coast are much more likely to consider the claim objectively on its merits, rather than giving Lincoln the benefit of the doubt.

California state also embraces the doctrine of notice prejudice. This means that unless the insurer can demonstrate actual prejudice from a late-filed claim, the insurer must accept and consider that claim. Many states will allow an insurer to deny a claim as late-filed automatically. Where insureds often do not have a diagnosis for medical issues in a timely period and only receive a diagnosis after they leave employment, insurers in many states have been able to avoid responsibility for those diagnoses by pointing to the fact that they were late-filed. When suit is filed in California, the insurer cannot escape its responsibility for the claim even if it is filed late.

A disability claim can be worth a seven figure payout in litigation, depending on your age and benefit amount. Like any major financial decision, sophisticated white collar professionals should evaluate their plan to pursue these benefits in advance, including the jurisdictions that are most supportive to their claims. A Meta employee who lives in New York, for example, has a 25% chance of being awarded benefits by the courts there. In California, it’s a 50% chance. You can double the strength of your litigation by making strategic decisions in advance.

If you are a Meta employee in a state other than California, you can still file suit in California and take advantage of the more favorable laws and courts for your litigation – if you have an attorney admitted to the California bar.

What Do You Need to Make a Late-Filed Claim?

For any claim, the support of your treating physician is paramount. You cannot make a successful disability claim if your doctor or therapist does not believe that you are disabled. Your treating physician does not need to be a medical doctor. Under the Plans, you need to be seeing anyone licensed to practice the “healing arts.” This can be a naturopath, a therapist, a psychologist, an osteopath, or other doctor. If you are a Meta employee who has received notice of termination but you are still employed, a claim will not be considered late-filed. If your doctor agrees that as of your last day of work you had restrictions and limitations, whether mental or physical, that precluded you from performing the material duties of your job, you can apply for disability benefits at Meta.

If you are making a claim after you have already left work, you need to demonstrate that you were treating for the symptoms that disabled you on or prior to your last day of work. You do not need to show a diagnosis, but you do need to demonstrate that you were experiencing symptoms of the disability and that you sought treatment for those symptoms, so medical records need to show treatment. Your treating medical practitioner will also have to be willing to complete paperwork confirming your disability and that it began on or prior to your last day of work. With that information, Lincoln will be required to accept and review your claim even if you last worked at Meta months or even years ago.

Obtaining Legal Counsel During the Appeal

Many insureds appeal the denial of their benefits themselves. Unfortunately, if the appeal is denied and litigation is required, your attorney will not be able to improve your position. Under ERISA, in the Ninth Circuit there is usually no discovery in litigation. A judge rules on the claim, and the judge is limited to the information in the claim file. That means that the appeal is the insured’s only chance to get all information into the file that would benefit the judge. This includes declarations under penalty of perjury from witnesses, additional medical records, letters from the treating physicians, independent testing to support the disability, issues with Lincoln’s doctors, and medical literature to educate the judge about the insured’s disability and diagnosis. The appeal isn’t just for Lincoln- it is the insured’s one chance to strengthen the file for litigation. Your attorney needs to be involved in the appeal.

An appeal within 180 days of denial is required. The insured cannot bring suit if there is no appeal and cannot appeal again or re-file the claim. If you fail to appeal under ERISA, you permanently waive the claim. As soon as a denial is received, an insured should contact counsel for assistance to give counsel time to perfect your appeal.

Where Monahan Tucker Law has attorneys and offices in Washington, California, Arizona, Oregon, and Nevada, it can assist Meta employees anywhere in the country and if necessary bring suit for its clients in the Northern District of California, because our attorneys are admitted to the court. We have deep and broad experience with the Meta disability policies and with Lincoln, and can help you through this difficult and stressful time and provide you the strongest tactical advantages in your claim or litigation.