Making a Disability Claim as a Salesforce Employee

Salesforce is headquartered in California, but has significant offices around the country. There are Salesforce corporate offices in New York; Seattle; Boston; Chicago; Atlanta; Washington DC; Denver; McLean, Virginia; Austin; Dallas; Denver; and Indianapolis.

For Salesforce 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. Salesforce employees need to understand that if they can demonstrate they were disabled before their last day of work, they are covered under Salesforce’s short and long term disability plans even if they have already left Salesforce 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 Salesforce Short Term Disability Plan

Salesforce’s short term disability plan is administered by Matrix Absence Management. Salesforce pays the benefits for the short term disability. The short term disability plan is 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. Salesforce will pay 80% of an employee’s “On-Target Earnings” up $5,000 per week under a short term disability claim. If you live in a state that offers paid disability, Salesforce will require you to apply for that disability benefit from the state, and will deduct the amount paid by the state from what Salesforce 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, an employee is disabled when “you suffer an injury or illness (physical, mental) which prevents you from performing your regular and customary job (or any reasonably related job).” The short-term disability plan requires the employe to provide “medical evidence,” a “doctor’s note,” and “any other relevant information required.” The “doctor’s note” must include a diagnosis with medical code, or a full description of symptoms if there is no diagnosis yet, the facts of relevant exams and medical history, the doctor’s opinion that the claimant is disabled, and the doctor’s estimated duration of disability.

The Salesforce Long Term Disability Plan

Salesforce’s long term disability plan is insured and administered by Metropolitan Life Insurance Company (“MetLife”). That means that MetLife pays the benefits it is reviewing. The long-term disability plan is insured by a policy issued by MetLife, and is subject to ERISA.

The long term disability plan takes over at 26 weeks. 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. For Class 1 employees, the Plan pays 66.67% of the employee’s monthly predisability earnings up to $20,000 per month depending on the insured’s annual salary. Class 1 is all active employees working at least 20 hours a week with a grade level of 10 or below. For Class 2 employees it pays 66.67% of the employees monthly predisability earnings up to $30,000. Class 2 is all actively executives working at least 20 hours a week with a grade level of 11 or above.

LTD benefits do include target commissions and target bonuses in the calculation of the monthly benefit. The plan excludes overtime, stock, retirement contributions, or any other type of compensation. Benefits are potentially paid up to age 67. MetLife 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 Salesforce, your LTD coverage is subject to a pre-existing exclusion. That means the condition is not covered if the insured “received medical treatment, care or services for a diagnosed condition; or took prescribed medication for a diagnosed condition; in the 3 months immediately prior to the effective date of coverage under this certificate; and the Disability caused or substantially contributed to by the condition begins in the first 12 consecutive months after the effective date of coverage under this certificate.” It is important to note that this language requires a diagnosis, which means that if an insured was treated for symptoms in the 3 months prior to the start of coverage, but had no diagnosis, the treatment of the symptoms would not bar coverage.

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 occupation must exist a reasonable distance or travel time from your residence or in the regional labor market if you reside in a metropolitan area. 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 Salesforce LTD plan includes no limitation on the amount of time you can be disabled by mental illness 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 Salesforce Employees Nationwide Can and Should Pursue Their ERISA Disability Insurance Claims in California Federal Courts

The Salesforce long term disability plan is governed by ERISA. MetLife 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. MetLife, 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. MetLife 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,MetLife 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 insured can explicitly bring suit – if it is filed where MetLife is headquartered, if it is filed where the insured lives, or if it is filed where the disability plan is administered. Salesforce 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 Salesforce 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 MetLife the benefit of the doubt.

California 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 Salesforce 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 Salesforce 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 service provided. This can be a naturopath, a therapist, a psychologist, an osteopath, or other doctor. If you are a Salesforce 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 Salesforce.

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, MetLife will be required to accept and review your claim even if you last worked at Salesforce 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 MetLife’s doctors, and medical literature to educate the judge about the insured’s disability and diagnosis. The appeal isn’t just for MetLife- 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 Salesforce 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 Salesforce disability policies and with MetLife, and can help you through this difficult and stressful time and provide you the strongest tactical advantages in your claim or litigation.