Kaiser Employee Denied Benefits

3-14-2013 20:57:00

SAN JOSE, Calif. (CN) – Kaiser Foundation Health Plan and Metropolitan Insurance Company is illegally denying a disabled man benefits, he claims in a complaint filed in the U.S. District Court, Northern District of California, San Jose Division.

Alexander Elsinga says he signed up for Kaiser’s Long-Term Disability (LTD) plan, serviced by MetLife, which promises to pay long-term benefits to policyholders who become “totally” disabled under the plan. Elsinga alleges in his complaint that he became totally disabled, but Kaiser and Metlife refuse to pay him benefits.

“The LTD plan was to provide long term benefits to Elsinga commencing Sept. 13, 2011 at 60 percent of Elsinga’s salary subject to offset by payments from California SDI and federal SSDI,” the complaint states. “Elsinga timely applied for benefits under the plan. The plan denied benefits to Elsinga on the basis that he was not disabled under the terms of the plan,” the complaint continues.

He appealed the denial on Feb. 20, 2013, but the plan denied Elsinga’s appeal in a “final and administratively binding decision.”

He is suing for all benefits owed him under the plan.

Melvyn D. Silver, of Silver & Taube, represents the plaintiff.