A federal court held MetLife wrongly denied disability benefits of a former Bank of America quality analyst in Seattle, Washington. Thus, the court ordered that MetLife pay her disability benefits and reasonable attorney’s fees.
Background
Ms. Harrison was employed by Bank of America as a quality analyst. Her last day at work was June 27, 2017. On that same day, Ms. Harrison went into labor. Labor and delivery was complicated and prolonged due to issues with an epidural anesthetic. Indeed, Ms. Harrison developed severe spinal headaches and was diagnosed with PTSD and post-partum depression. Because of these complications, Ms. Harrison was physically unable to return to work.
MetLife’s Denial of Short Term Disability Benefits
Ms. Harrison reported her claim to MetLife on July 20, 2017, 23 days after she ceased working. MetLife denied her claim claiming it was late. MetLife cited to its policy which required that Ms. Harrison initiate her clam no later than 15 days after the date of disability. However, the policy also stated that a claim could be made later than 15 days if circumstances “such as a loss or impairment of cognitive function,” made it impractical to file on time.
After denying her claim, MetLife informed Ms. Harrison she could appeal the decision. MetLife also notified her that she could submit evidence that circumstances made it impractical for her to start her claim within 15 days.
Thus, Ms. Harrison appealed the denial. She notified MetLife of the issues with her labor leaving her bedridden and with disabling pain. Additionally, her doctor submitted a letter to MetLife stating it was reasonable that she was not able to file a claim on time. Still, MetLife decided there was no evidence of cognitive impairment and denied her appeal.
The Court’s Decision
The court concluded that Ms. Harrison submitted enough evidence showing it was not practical for her to file a claim within 15 days of disability. The court held MetLife wrongfully required evidence of a loss of impairment or cognitive function. This was a misreading of the policy. The policy did not require such finding, but included such as example of circumstances making it impractical to file a claim.
In conclusion, the court found MetLife was wrong in denying Ms. Harrison’s claim for STD benefits and awarded her short-term disability benefits.
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