Kaiser, MetLife Underpaid Benefits, Woman Claims
5-5-2015 23:55:00

SAN FRANCISCO (CN) - Kaiser owes a woman benefits from a long-term disability insurance claim that was misclassified, she alleges in a federal lawsuit.

(Suit dismissed June 4, 2015.)
Former Kaiser employee Peggy Roach became disabled in 2001 and began receiving long-term disability benefits under the Kaiser Permanente Flexible Benefit Plan. Her benefits were terminated in 2003, but were reinstated in 2005 following a lawsuit.
The benefits were terminated again in 2012, but were approved in 2014 following an administrative appeal to loan administrator Metropolitan Life Insurance Company. The benefits, however, were classified as new benefits, which affected Roach’s payout.
Specifically, Roach says that following the appeal, “MetLife approved benefits as of Jan. 31, 2012, contending this was a new claim, and imposing a new 90-day elimination period. MetLife assigned a new claim number. In fact, benefits should have been approved as a continuation of the original claim from 2001.”
In addition, MetLife also found Roach “unable to perform the duties of any occupation,” which she says “is the wrong definition of disability for a new claim, and is only consistent with the 2014 decision being a continuation of the old claim.”
She says MetLife miscalculated her benefits by treating her as a new claim and imposing the 90-day waiting period, “significantly” underpaying her from Jan. 18, 2012 to the present.
Roach is suing Kaiser and MetLife under the Employee Retirement Income Security Act. She wants the court to award her back payments with prejudgment interest, and $150,000 in attorneys’ fees.
Roach is represented by Laurence Padway, in Alameda, Calif.