Lyme Disease – Successful Appeal of a Denied Long-Term Disability Claim with MetLife

Our office was recently successful in obtaining a reinstatement of long-term disability (LTD) insurance benefits reinstated for a woman with Chronic Bacterial Infections.  “Mindy” was diagnosed with Lyme Disease in 2009 and now suffers from Chronic Bacterial Infections.  MetLife originally approved Mindy’s claim for long-term disability benefits in 2009 as it determined she could no longer perform the duties of her prior occupation, at which Mindy earned a substantial salary plus bonuses, which were calculated into her monthly benefit.

In May of 2013, MetLife terminated Mindy’s LTD benefits, stating she had the physical capabilities to work in another gainful occupation.  After reviewing the basis of MetLife’s denial of benefits, we realized that MetLife ignored had essentially ignored an important provision in long-term disability policy which states that MetLife must identify occupations where the claimant was capable of earning 80% of their predisability earnings (an “earnings qualifier”).  MetLife had made no real effort to identify alternate occupations based on Mindy’s work history and experience, and in which she would earn 80% of her salary.

Mindy contacted our office with help in preparing an appeal of MetLife’s adverse benefit decision.  In addition to identifying the deficiencies in MetLife’s conclusion, we suggested she submit to a Functional Capacity Evaluation and a Neuropsychological Assessment in order to show she lacked physical abilities necessary of a sedentary occupation and that her condition had affected her cognitive functioning such that she could not return to a high-earning occupation.  Mindy’s condition is somewhat controversial within the medical community as some physicians do not take the view that complaints such as Mindy’s are related to Lyme Disease or chronic infections.  These outlier physician tend to instead accuse patients of malingering. We also spoke with Mindy’s medical treaters who were more than willing to write supportive letters and to specifically explain why she was unable to work the required schedule.

Ultimately, MetLife agreed with the arguments presented in our appeal and correctly chose to reinstate her LTD benefits.

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