One court addressed this in Haase v. Metropolitan Life Ins. Co., (E.D. PA 2016), Mr. Haase was receiving long-term disability benefits (LTD) for about ten years. During that time, he challenged MetLife's calculation of an offset of worker's compensation benefits which reduced his long-term disability benefits. The challenge went back about ten years, but he did not file suit until 2015. MetLife argued that Haase could not go back and demand a recalculation of these old benefit decisions because that initial LTD decision was now time-barred. The court agreed and found the claim barred under the disability plan's contractual three-year limitation of action provision. Also, it was barred under the four-year statute of limitation for Pennsylvania breach of contract claims.
Haase argued the court should toll the limitation of action and statute of limitations while he went through MetLife's claim process. The administrative appeal process took too much time, but that was too bad for Mr. Haase according to the court.
Benefits paid monthly, so a new decision is made with each benefit payment. So is the court contending the first benefit decision became “the law of the claim” and applied to all subsequent monthly decisions? If so, this case is interesting from the standpoint of whether the old saying “what is good for the goose is good for the gander” will be applied in other cases. If your insurer or plan administrator suddenly announces that it has overpaid your claim for many years and now wants a large sum of money, call us to see if we can help. It may be too late for them to do this. What is good for the goose is also good for the gander, right?