After a lengthy battle with MetLife, our office obtained a great result on behalf of a disabled client who had been mistreated by the claims department at this insurance company. Mr. K suffered a severe reaction to the drug Levaquin resulting in multiple problems with his nervous system, nerves and muscles. MetLife initially agreed Mr. K was disabled and approved his claim for several years. Later, MetLife scheduled him for an Independent Medical Examination (“IME”) but it was later cancelled by the reviewing physician with nobody bothering to inform Mr. K. Attempts to reschedule were unsuccessful. Despite this confusion over the requested IME, which was clearly not the fault of Mr. K, MetLife terminated payment of his long-term disability insurance benefits. Our office then became involved. The IME was allowed to move forward after which this office pursued and appealed MetLife’s termination of benefits. Despite our efforts, MetLife continued to deny benefits which led to the filing of a lawsuit.
Nearly two and a half years later, on June 1, 2016, the court issued its Order reversing MetLife’s decision to terminate benefits. Our client was of course overjoyed by the court’s conclusion. Past due benefits into the six-figures have now been paid to our client. His claim has been returned to an approved status and monthly benefit checks will be received moving forward.
Ban on Discretionary Clauses and De NovoReview
The judge’s determination was important on several levels. Our office argued the applicability of an Illinois discretionary ban statute, similar to the statute in Colorado. These discretionary ban statutes are intended to address what many believe to be an unfair and unreasonable approach to a court’s review of an ERISA-governed benefit dispute. The statute provides that such review is to be performed “de novo” as opposed to the “arbitrary and capricious” standard of review which directs the court to give significant deference to an insurance company’s decision to terminate benefits, even though that very insurance company benefits financially from a decision to deny a claim. MetLife argued that the 2007 Illinois ban did not apply in this situation because the initial effective date of the group disability policy issued by MetLife to Mr. K’s employer predated the statute’s effective date in 2007. Following a detailed analysis of the issue, the court agreed with our position that a group disability policy which renews annually is subject to the law banning discretionary clauses, such that the court applied the de novo standard of review.
SSDI Decision and Treating Doctor Opinions Must Be Considered
The court also disregarded MetLife’s argument that the scope of the record should be limited and that MetLife’s neuromusculoskeletal limitation applied. The court’s order is also significant in its acceptance of the principle that it is improper to terminate benefits when there is no change in the person’s condition, and, in fact, in Mr. K’s situation, there was more documentation of the disability and its cause than there was prior to the claim being terminated. Other issues successfully pursued by this office included MetLife’s failure to give the Social Security Administration’s determination of entitlement to SSDI proper weight when MetLife benefited from such decision and required Mr. K to apply, that little weight should be given to the paper reviews performed by the insurance company’s hired doctors when they simply rely on an alleged lack of evidence, and that a treating physician’s opinion is entitled to more weight if the report is well-reasoned.
After what turned out to be a multiple year battle, MetLife’s decision was overturned by the court and all past due benefits have now been received by our client. Currently, Mr. K remains on claim with MetLife, while McDermott Law will continue to monitor MetLife and the claim with a goal of reducing any chance of benefits being terminated again in the future.
If your LTD benefits have been wrongfully terminated or denied, contact a Denver disability lawyer at McDermott Law, LLC for experience in standing up to insurers and help in obtaining the benefits you likely deserve. Call (303) 964-1800 or email us using the contact form on this page to find out more about how we can help you.
From offices based in Denver, we provide the highest quality legal services to disabled people throughout the state of Colorado, the surrounding states and nationwide.