WASHINGTON – Agatha Sokoloski chose the wrong day to miss work.
A federal appeals court ruled Thursday that the long-time Baltimore Gas and Electric Co. employee was not eligible for disability benefits because she was out on sick leave the day the company switched insurers, and never returned.
But in a sharp dissent, Senior Circuit Judge Cynthia Holcomb Hall said the Elkton resident deserves a new hearing in district court.
“The system has failed Agatha Sokoloski,” said Hall, disagreeing with the rest of the 4th U.S. Circuit Court of Appeals panel. “Justice requires us to recognize Sokoloski’s obvious claim.”
Sokoloski was a sales and service supervisor with 20 years at BGE when she took sick leave on Aug. 25, 1997, on her doctor’s advice, to rest up for knee surgery two weeks later.
On Sept. 1, while Sokoloski was out, the company switched its disability insurer from Cigna to Metropolitan Life. Under MetLife’s policy, if a BGE employee was not “actively at work” on the day of the switch, that person’s coverage would start the day the employee returned to active work.
But Sokoloski, who had undergone unrelated back surgery in 1982, never worked again. She used crutches and a cane after the knee surgery, and consequently her back deteriorated. She resigned in February 1998, after her paid leave was gone.
In November 1997, Sokoloski filed a claim with Cigna for long-term disability benefits, claiming that chronic knee and back pain prevented her from working. Cigna denied the claim, stating that Sokoloski was able to resume phone duties by October 1997, despite her total knee replacement, and that she had not met the 180-day waiting period to prove her back condition was disabling.
Circuit Judge William Traxler wrote that Sokoloski should have appealed Cigna’s denial. Instead, she submitted a disability claim in May 1998 to MetLife. It denied the claim because she was not “actively at work” on the first day of the plan and never returned.
Sokoloski unsuccessfully contested that denial, then sued. But U.S. District Judge William Nickerson dismissed her claim, and the appellate court agreed Thursday.
MetLife agreed that Sokoloski would have been eligible for disability coverage had she returned to work, according to court documents. Her attorney, Wayne Goddard, said that had she worked Sept. 1, 1997, and gone on bed rest Sept. 2, “it is crystal clear she would have been entitled” to disability benefits from MetLife.
MetLife spokesman John Calagna could not speculate on whether the insurer would have paid benefits on a claim for her back problem. As for her knee, he said, she should have pressed the issue with Cigna.
“The issue here is that . . . Cigna said there was no disability with the knee. She had over a year to appeal, and she did not do that,” Calagna said.
“We have a contract with the company,” he said. “We don’t have room to maneuver.”
Goddard declined to comment Friday on the Cigna claim. He said he and Sokoloski have not decided on their next step, but are “investigating all options.”
Goddard said Sokoloski currently receives Social Security disability benefits.
BGE declined to comment because “we weren’t directly involved.”