MetLife long term disability benefits were approved for our client after we filed an appeal under ERISA claiming MetLife wrongfully denied his claim. Our client had a MetLife long term disability insurance policy through his employer when he suffered from a stroke and other unrelated medical conditions. He worked for an electrical company for many years and even continued to work after he became impaired.
MetLife claimed he did not meet the definition of totally disabled under his employer’s plan. He suffered a stroke in 2009 and returned to work in 2010. However his employer made many accommodations to meet his needs including reduced hours, oversight of tardiness and absences, and a decreased workload. No other employer would have allowed for these conditions. He was only able to work, even under the special conditions, until 2015 when he left the company and filed for Metlife long term disability benefits.
The stroke left him with mental impairments including loss of concentration and delayed processing. Secondary to the stroke, he was diagnosed with severe depression and anxiety and a number of other medical conditions. Taken as a whole, his medical issues left him with a total disability and unable to perform the duties of any occupation. His medical records and doctor’s reports concluded that working 6 hours per day would be unreasonable and unsafe for him.
In the denial letter, MetLife relied on the flawed reviews of its two paid medical consultants. One of the opinions is based on a paper review of our clients medical records. In the opinion, the doctor provided no reason as to why she believed our client was able to continue working in his job. The doctor also disregarded much of the medical opinions of our clients treating doctors. She cherry-picked the records to support her opinion that he could work.
Importantly, the doctor also notes that because our client returned to work after the stroke, he is not disabled. His employer submitted an employer questionnaire which clearly showed how our client was given accommodations for his physical and mental impairments because of his history with the company. No other employer would have allowed for that kind of behavior from an employee.
Our appeal included a letter specifically laying out the medical conditions from which our client suffers. We also argued that MetLife relied on the opinions of their own doctors who did not provide a reasonable explanation for their conclusion that he could work. This is contradictory to what the law requires under ERISA. Lastly, we provided a complete medical history including doctors reports and independent medical examinations that unequivocally show our client is totally disabled.
MetLife reversed their denial and awarded our client the long term disability benefits he was due.
Because each client’s case is unique and has different facts, results similar to those in other clients’ cases are not guaranteed.
