A lawsuit was filed in California by a man who had his long term disability benefits wrongfully terminated by Metropolitan Life Insurance Company (“MetLife”). Mr. Lin was receiving long term disability insurance benefits for chronic renal failure after an organ transplant. He was receiving benefits for about two years when MetLife terminated his benefits.
In the first termination letter, MetLife cited the incorrect definition of disability and the wrong description for his occupation as well stating medical documentation failed to prove ongoing disability. He appealed the denial and provided additional information to support his continued disability. MetLife sent a second termination letter. Although the second letter used the correct definition of disability, MetLife still cited the same reasons for termination.
Mr. Lin filed a lawsuit under ERISA law having had his long term disability benefits wrongfully terminated. MetLife argued that Mr. Lin’s lawsuit should be dismissed because he did not complete the appeals process with MetLife (also known as exhausting administrative remedies).
ERISA requires plaintiffs to first go through the appeals process with insurance companies before filing a lawsuit in federal court for disability benefits. However, there are exceptions to this general rule. A person does not have to exhaust the administrative remedies if doing so would be useless or if the ERISA disability policy does not have claims procedures as required by ERISA.
In this case, the Court found that MetLife failed to show where the disability policy specifically states the exhaustion of administrative remedies requirement. As a result, the Court found in favor of Mr. Lin and ruled that he could proceed with his lawsuit against MetLife.
Appealing a denial or termination of disability insurance benefits can be tricky, especially if ERISA applies to the disability claim. If you feel your disability benefits have been wrongfully denied or terminated, contact Dabdoub Law Firm for a consultation with one of our experienced disability insurance lawyers. We have helped numerous people overcome the complicated and tricky process of appealing an insurance company’s decision with favorable outcomes for our clients.
