I had neck surgery in August 2007 and will be out of work until Feb. 2008. I received five checks from the insurance company, then they called and stated they had made a mistake and I was NOT eligible for short term disability. Now they want the money back. Of course I have used the money to pay medical bills and am unable to give any money back while Im out of work. Is this legal? Can they really demand the money back even though I was honest about my medical conditions and dates treated before the surgery? It seems that they should just write it off since it was there misttake. What are my options here?

Emland

Were you eligible or not? If you took money on false pretenses (i.e. knowing you were not eligible) then you will have to pay it back.

Piano Player

To Emland, thanks for answering my question. Short term disability is not my area of expertise and this was my first time trying to use it. I expected Metlife to know if I was eligible or not and trusted them. The payments were an answer to prayer for me. As I said in my answer, I withheld no info from them. Apparently they just messed up and the case worker implied that they mess up all the time by giving someone payments and then saying "whoops, you weren't eligible. We want our money back". I need to know if I have any 'rights' in this situation. Is this legal for them to take back the money from someone who thought they were eligible and was honest about their medical condition?

excon

Hello P:

If you weren't covered, then you have to pay it back. It's a mistake. It's just like if you paid too much by mistake, you'd get your money back. Nobody has the right to keep money under those circumstances. Because you believed them doesn't confer any rights on you.

Yes, they are bad and wrong.

excon

Emland

Sounds like you need to have a discussion with your HR department. Short term disability insurance covers things like surgery in most cases. I would make certain that it does NOT cover your situation before paying them back or making payment arrangements.
It is time you read your policy from top to bottom and become completely familiar with what it does and does not cover.

And like Excon said, if you were ineligible, it was an accounting error and you have to pay it back.

jef1056

Sounds strange. They should know pretty quickly if you eligible for payments. What was the reasoning for determining that you were paid in error?