In Metropolitan Life Ins. Co. v. Cotter, the Massachusetts Supreme Court just rendered an opinion on March 15th interpreting requirements under an “own occupation” policy that was not subject to ERISA. The plaintiff was diagnosed with cancer and was thereafter terminated from his employment. Metropolitan Life paid benefits under the “own occupation” policy for some time and the plaintiff eventually found employment is a less stressful job. At that time Metlife filed a declaratory action asking for a determination that its obligation to pay benefits ended and also asked for a determination that it was owed a refund of paid benefits. The Supreme Court of Massachusetts held that because the plaintiff was no longer receiving treatment for the condition that caused the disability, and was therefore not seeking treatment to return him to his former occupation, that the obligation to pay benefits ended. The court at least found that the plaintiff did not have to repay any benefits he received while in the new job.
If you have an “own occupation” policy read the policy’s terms and conditions carefully. Some of these policies allow for other work if you are unable to return to your former occupation. Other “own occupation” policies also allow for employment in other jobs and then take an “offset” of the owed benefits for the income from the new job. If you have an “own occupation” policy and have any questions regarding the policy’s conditions, feel free to contact the lawyers at Burke Harvey & Frankowski, LLC.