I've represented several individuals who have worked for "The Church" (short for The Church of Jesus Christ of Latter-day Saints) here in Utah when they've had a dust up with Deseret Mutual for their benefits. Inevitably, since it's owned by the "The Church," they approach Deseret Mutual like it's a charitable institution. They think that with a simple "howdy," a wink, a handshake, a showing of church credentials and a hard luck story it won't operate like all such businesses- acting and interpreting everything to maximize profits.
"The Church," somewhat encourages this avuncular, charitable myth by stating on its website that, "Deseret Mutual is not an insurance company. Rather, it’s a non-profit trust ... [O]ur mission ... is to improve our members’ health and financial security. [and to] administer the generous benefits sponsored by our participating employers..." (https://www.dmba.com/nsc/dmba/History.aspx)
As a consequence, many church employees are naive and get taken to the cleaners because they don't do what is necessary to establish their claim. In the case of a dispute, they often have not put forth their strongest position so that they can win when legally they should. They are thereby taken advantage of. Don't get me wrong, I'm not saying DM is evil or violating any law or necessarily even recognizing it is engaging in convenient self-serving interpretations of their own policies or plans. What, I am saying is it's a business, like any other, and the naive shouldn't expect anything different.
In a current case, DM is denying benefits under a 24 month limitation for disability benefits for "fatigued-based illness." It does not specifically define what it means by "fatigued-based illness," but in general requires that the employee and doctors are still trying to determine the cause of the fatigue during the limitation period.
My client has a specific, objectively determined diagnosis that causes his fatigue and the limitation doesn't apply nor does any exclusion. He should have gotten his benefits. Yet DM has engaged in a result-oriented analysis to deny benefits. I suspect this is because the diagnosis is an unusual but severe disease process. However, if "The Church's" analysis is correct (which it's not) heart failure, lung disease, circulatory diseases, and so on and so forth, would be considered "fatigued-based" illnesses.
The upshot is that since my client didn't have early help, he now has to litigate and is at a higher risk of loss since his claim wasn't set up well at the onset. I'm still confident we will prevail. The take away is that when you work with any organization on the business side of things, don't be naive. Get guidance early--they are not going to cut you any slack and they only see things one way- their way.
©Loren M. Lambert September 4, 2015
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