Successful Case Stories

At Eric Buchanan & Associates, our team has helped many people fight denials of disability insurance, ERISA insurance, and similar insurance claims. Here are examples of our successful cases.

Unreasonable review of fibromyalgia ruled arbitrary and capricious:

Fibromyalgia, chronic pain, depression, and various other conditions; benefit awarded:

Our Client v. Metropolitan Life Insurance Co.
United States District Court for the Eastern District of Tennessee (2006)

Our client suffered from fibromyalgia, chronic pain, depression, and various other conditions, which rendered her incapable of continuing her job as a senior auditor. She had disability insurance through her employer, but when she applied for benefits, MetLife, the insurance company, denied her claim. 

We fought for and won a reversal of MetLife’s denial.  The court acknowledged our client had six treating doctors supporting her disability, that MetLife had improperly required “objective evidence” of her disability, despite relying on the opinions of doctors hired by MetLife who only reviewed our client’s records.  

After that, we asked the court for further clarification of the benefits owed to our client. We requested compensation for additional benefits that MetLife owed our client and for interest on the long-term disability benefits that MetLife had wrongfully denied our client. 

The court granted our client pre-judgment interest on the benefits she was owed and other collateral benefits—including reinstatement of her life insurance at her pre-disability level, the option to reinstate her eligibility for a normal pension retirement, and reimbursement of life insurance premiums she paid after becoming disabled.

To learn more about Our Client v. Metropolitan Life Insurance Co., click here.

 

Ischemic cardiomyopathy, dyspnea and a left bundle branch block; benefit awarded:

Our Client v. Unum Life Insurance Company of America
United States District Court for the Eastern District of Tennessee (2020)

Our client developed severe heart conditions, including ischemic cardiomyopathy, dyspnea and a left bundle branch block, that rendered her unable to continue her work as a grant administrator for a non-profit. She applied for long term disability benefits from Unum Life Insurance, which agreed she was disabled and provided her benefits for two years.

After 24 months of benefits, the definition of Disability in the policy changed to “when Unum determines that due to the same sickness or injury, [someone is] unable to perform the duties of any gainful occupation for which [someone is] reasonably fitted by education, training or experience.” Unum found that our client was not disabled under the any occupation definition of disability in the policy and terminated her benefits. She filed a timely appeal and submitted several opinions from her treating providers outlining restrictions and limitations which prevent her from performing sedentary work. Unum maintained its decision, stating that our client is able to perform sedentary work based on the opinions of its file reviewing physicians. We brought suit on behalf of our client for judicial review of Unum’s decision.

The court reviewed the case under a de novo standard of review, under which the judge draws an independent conclusion based upon materials provided on the record. The court decides the case without deference to the insurance company’s decision.

To learn more about Our Client v. Unum Life Insurance Company of America, click here.

Our Client v. Unum Life Insurance Company of America
United States District Court for the Eastern District of Tennessee (2022)

Our client developed ankylosing spondylitis (a painful inflammatory arthritis condition) that progressed over time, though he kept working as a production supervisor for a packing company for as long as possible despite his worsening condition.  When it became too painful and began impacting his ability to complete his work and even daily activities, his doctor supported him as disabled and, after filing his claim, he initially received short-term disability benefits from Unum Life Insurance.  But after paying his short term benefits, Unum denied his request for long-term benefits.  

Unum’s long-term disability plans delegated to itself the authority to determine if someone qualifies for long-term benefits, so under ERISA the standard of review favored upholding its decision unless our client could show its denial was “arbitrary and capricious.” After being denied long-term disability benefits, the client retained our services and we helped him gather important medical and vocational evidence confirming his disability and submit it to Unum as part of his appeal. Unum did not conduct an independent medical examination, despite our client’s physician’s suggestion, opting to make its decision using only file reviews from in-house physicians. Following its review, Unum rejected our client’s appeal, and we sued to overturn Unum’s decision.

To learn more about Our Client v. Unum Life Insurance Company of America, click here.

Life Insurance, Breach of Fiduciary Duties, ERISA Fiduciary:

Our Client v. Sun Life Assurance Company of Canada
United States District Court for the Middle District of Tennessee (2014)

In this case, an employer allowed an employee to enroll in significantly more life insurance than the employee qualified for. When the employee was later killed, we successfully argued that their surviving children should be awarded the full amount of life insurance that was promised, an additional $784,000.

[The district court chose not to officially publish this case, but it is available on Westlaw. The important information about the decision is found throughout three decisions on Westlaw. First, the district court judge assigned a magistrate judge to write a recommended decision, called a “Report and Recommendation” or “R&R.” The R&R contains most of the information about the basic facts and recommends that our client’s claim for the greater benefits be granted. The court’s official decision in favor of our client’s claim is the decision of the district court judge, The district court judge’s opinion is the official decision, but it does not contain all the factual details found in the R&R. After finding in our client’s favor, the court invited another round of briefing on the remedy available for our client’s family and issued another order granting the claim for the full amount of life insurance promised.

To learn more about Our Client v. Sun Life Assurance Company of Canada, see more.

ERISA regulations, ERISA appeal deadlines, Unum, Provident, ERISA conflict of interest:

Our Client v. Provident Life & Accident Insurance Company
United States District Court for the Middle District of Tennessee (2014)

The plaintiff, in this case, stopped working as a production assistant for Nissan due to lower back pain and took disability leave on December 15, 1999. On June 16, 2000, our client submitted a claim for long term disability benefits under a group policy administered by Unum. On July 23, 2000, Unum approved our client’s claim and paid them long term disability benefits until 2012.

In an April 11, 2012 letter, Unum notified our client that it was terminating their long term disability benefits and gave them 90 days to appeal the denial of benefits. Our client hired a different attorney before us, who did not file an appeal within the 90 days. After the 90 days was up, our client hired us, and we appealed on their behalf within 180 days, and we argued to Unum that they should have allowed them 180 days to appeal.

Unum refused to consider the appeal we sent in, claiming that they could require our client to appeal under a shorter 90-day deadline because their claim was controlled by an old version of their policy and older ERISA regulations.

We argued that Unum could not use that shorter deadline, because the policy, or plan, under which our client was covered, had been amended while they were being paid benefits. The new version of the plan allowed for a full 180 days to appeal, as was required by more recent ERISA regulations. The court ruled in our client’s favor, citing that their appeal was filed on time and that Unum was arbitrary and capricious to require them to appeal in the shorter time. Rather than addressing whether they were disabled or not, the court remanded the case back to Unum to require them to finish their decision-making process.

To learn more about Our Client v. Provident Life & Accident Insurance Company, see more

Back Pain:

Our Client v. United of Omaha Life Insurance Company
United States District Court for the Western District of Tennessee (2013)

After a year of increasing back pain, our client had to leave their job as a legal assistant. After paying our client short term disability benefits for the maximum amount of time, United of Omaha denied our client’s claim for long term benefits. Relying on the opinions of three file reviewers who had not conducted physical examinations of our client, Omaha denied their claim. The court held that Omaha’s reliance on these file reviews was arbitrary and capricious under the circumstances, because Omaha had failed to exercise its right to conduct a physical examination and because the file reviewer’s reports contained only conclusory statements not supported by evidence. The court remanded our client’s claim to Omaha to conduct a fair evaluation of its merits.

To learn more about Our Client v. United of Omaha Life Insurance Company, see more.

Gorlin’s Syndrome, skin cancer:

Our Client v. Hartford Life & Accident Insurance Company
United States Court of Appeals for the Sixth Circuit (2013)

After working for Navy Federal for thirty-two years, our client had to stop working due to Gorlin’s Syndrome, a rare genetic defect that caused them to develop numerous skin cancers which had to be removed. By September of 2007, our client was having such frequent procedures that they could no longer remain employed, so they filed a claim for long term disability benefits. Hartford originally awarded our client benefits but later terminated their benefits when Navy Federal allowed our client to work from home. Our client appealed, arguing that they were unable to even work from home due to the frequency of their surgeries and the accompanying recovery time.

Hartford relied on the opinion of a file-reviewing expert that our client would require three to four days to recover from each surgery, despite our client’s treating dermatologist opining that they would need a week to recover. Additionally, Hartford determined that the amount of time our client would be unable to work while recovering was not frequent enough to preclude work; however, in calculating how often our client had surgeries, Hartford reviewed our client’s prior history and included months during which our client did not claim to be disabled and was still working.

Hartford also relied on the opinion of a file-reviewing physician who tried to speak with our client’s treating doctor but was unable to reach him. When the treating physician later provided information that contradicted Hartford’s file-reviewing doctor, Hartford erroneously continued to rely on the file reviewing the doctor’s opinion.

Finally, Hartford’s vocational expert declared that “the common practice of employers” regarding sick days would accommodate our client’s frequent absences but did not cite to any national data or information from Navy Federal. The court held that Hartford’s denial was arbitrary and capricious, because Hartford did not have sufficient evidence that our client’s recovery time was only three to four days, did not accurately calculate the frequency of our client’s surgeries, and relied on the vocational expert’s opinion that did not cite any evidence or data.

To learn more about Our Client v. Hartford Life & Accident Insurance Company, see more.

ERISA, Lincoln National, fibromyalgia:

Our Client v. Lincoln National Life Insurance Company
United States District Court for the Middle District of Tennessee (2012)

Our client, a senior payroll specialist at Alive Hospice, became disabled due to the chronic pain and fatigue caused by fibromyalgia, and they applied for long term disability benefits under a plan offered by their employer and administered by Lincoln National. To qualify under the plan for long term disability benefits, our client had to be totally disabled, as defined by the plan.

Lincoln National denied our client’s disability benefits twice, and then we sued the insurance company under ERISA. Lincoln National argued that our client’s medical records did not contain objective evidence of total disability, and, therefore, our client was not totally disabled and could do their job.

We argued, and the court agreed with us, that our client’s pain was the central basis for their disability and that their fibromyalgia was the key consideration in the determination of their total disability. Fibromyalgia, a condition that cannot be documented by medical tests, made Lincoln National’s reliance on the lack of objective medical evidence arbitrary and capricious.

To learn more about Our Client v. Lincoln National Life Insurance Company, see more

ERISA discovery, Unum, Provident, ERISA conflict of interest:

Our Client v. Provident Life & Accident Insurance Company
United States District Court for the Eastern District of Tennessee (2011)

Before going into the facts of this case, it is necessary to point out that what follows is not a decision or opinion on the whole case. Rather, it is regarding a discovery order along the way. This is important because courts do not always allow discovery in ERISA cases. When we argue for discovery and are successful, it is worth noting.

On behalf of our client, we asked the court to require Provident, the insurance company to provide us information about their bias in claims handling, which would affect the court’s standard of review. Under ERISA, insurance companies often get the benefit of the doubt, but evidence of bias in their decision-making can mean they get less deference in court.

We argued, and the court agreed with us, that normally a party cannot get discovery to add to the merits of an ERISA case, but can get new information about an insurance company’s biased and unfair claims handling. So, for example, the court agreed that our request for monthly trends reports from the insurance company should be granted because the reports showed the company’s bias against granting disability benefits claims.

To learn more about Our Client v. Provident Life & Accident Insurance Company, see more.

Denial over turned, benefits awarded:

Our Client v. Metropolitan Life Insurance Company
United States District Court for the Eastern District of Tennessee (2011)

This is a Report and Recommendation by the Magistrate Judge, recommending a favorable decision for our client. The district court judge over the case accepted this Report and Recommendation and entered a final order approving benefits for our client.

This case was our client’s second time in court for their claim. In their first case, the court found the insurance company to have acted arbitrarily and capriciously, but rather than pay benefits the first time, the court remanded back to the insurance company. After the insurance company again denied our client’s claim, we brought the case back to court and finally won our client the benefits they were entitled to.

In this second case, the court explained again, but in more detail, the history of our client’s case. Our client became disabled and had to stop working at U.S. Enrichment Corporation’s (USEC) Paducah Gaseous Diffusion Plant as a Health Physics Technician in October 2001 due to major depression and anxiety. The court noted the plant was the only place in the United States that enriched uranium and the Paducah Gaseous Diffusion Plant was one of the top five targets in the September 11, 2001, terrorist attacks.

Our client had received long term disability benefits from MetLife because of their disability that began in October 2001, but eventually, MetLife arbitrarily and capriciously terminated their benefits based on a supposed lack of information. MetLife had ignored the extensive information showing they had been diagnosed with Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder with Agoraphobia, Obsessive-Compulsive Disorder, and Post-Traumatic Stress Disorder. Ultimately the court agreed with us that it was arbitrary and capricious to deny benefits because MetLife did not conduct an independent medical examination of our client and did not ask for the tests that it said were missing. Finding that MetLife made the same type of mistakes it had the first time, the court reversed MetLife’s termination of our client’s long term disability benefits and awarded their benefits.

To learn more about Our Client v. Metropolitan Life Insurance Company, see more.

Insurance company is wrong to rely on file-reviewing doctors who ignored evidence and to fail to have claimant examined when the court suggested it. Evaluation of disability caused by mental health issues.

Our Client v. Metropolitan Life Insurance Company
United States District Court for the Eastern District of Tennessee (2011)

This is the last order in this long case in which MetLife refused to pay benefits, continuing to rely on doctors who only reviewed the file, and did not do a good job of doing that. The district court in Tennessee first remanded the case, making MetLife re-do its decision because when they denied our client’s case the first time, MetLife had denied them before giving them a chance to submit the evidence MetLife later said they wanted, and then MetLife arbitrarily relied on a file-reviewing doctor over the doctors who actually treated our client. When MetLife had a second chance to get it right MetLife denied the claim again. We took the case back to court, and the Magistrate Judge issued a new Report and Recommendation finding MetLife’s decision to deny was so bad that it should be overturned and MetLife should have to pay our client benefits. MetLife appealed the Magistrate Judge’s order, still trying to deny our client’s benefits, but the District Court Judge over the case issued this order, confirming that MetLife should have paid the benefits. The court again explained that MetLife’s decision to ignore our client’s treating doctor, to rely only on a file-reviewing doctor, and MetLife’s choice not to have our client examined in person, was a “compelling factor” in deciding MetLife was arbitrary and capricious. MetLife also was wrong to rely on the file-reviewing doctors who picked and chose just parts of the records they reviewed to say our client was not disabled, while MetLife’s doctors ignored other parts of the records that showed how our client was still disabled.

To learn more about Our Client v. Metropolitan Life Insurance Company, see more.

ERISA & Long-Term Disability; termination of benefits reversed

Our Client v. Nortel Networks Short Term & Long Term Disability Plan
United States District Court for the Middle District of Tennessee (2009)

This ERISA case came to trial because the insurance company cherry-picked which medical information to give weight in determining the Plaintiff’s long term disability status. Specifically, the insurance company totally ignored the treating doctor. Also, the insurance company improperly ignored the Plaintiff’s complaints of pain and did not examine them. We sued the insurance company on behalf of our client under ERISA because their long term disability benefits were denied. The court agreed that the insurance company was wrong, arbitrary, and capricious and reversed the termination of the Plaintiff’s long term disability benefits and remanded the case to Prudential for a proper decision.

After a year and a half of increasing back pain, our client had to stop working as a systems design engineer for Nortel Networks, Inc. They received short term disability benefits and some long term disability benefits before Prudential denied their long term disability benefits on May 18, 2005. Prudential gave credit to the April 2004 opinion of one of our client’s treating physicians, Dr. Gracer, and awarded long term disability benefits starting May 18, 2004. Yet, one year later, Prudential did not consider all of Dr. Gracer’s February 2005 “Work Status Form.” Prudential focused only on the portions of the “Work Status Form” that were helpful to the Plan.

Prudential improperly ignored the Plaintiff’s complaints of pain, without an examination. Prudential simply relied on its paid medical file consultation with its in-house doctor, Dr. Syrjamaki, to discredit Plaintiff’s complaints of pain, ignore Dr. Gracer’s limitations and restrictions, and uphold its decision to deny long term benefits.

To learn more about Our Client v. Nortel Networks Short Term & Long Term Disability Plan, see more

Cerebral hemorrhage, bleeding in the brain, stroke; life insurance, life waiver of premium, coverage if insurance company changes while a person is disabled:

Our Client v. Sun Life Assurance Company
United States Court of Appeals for the Sixth Circuit (2009)

We helped our client to obtain life insurance benefits under a policy that allowed them to keep their life insurance if they had been disabled when they stopped working. Our client became disabled due to a cerebral hemorrhage, or a stroke, which caused them to have to stop working. Our client tried to go back to work but was unable to fully perform their job, and they stopped working entirely after a few months. Their employer offered a life insurance policy that they could keep after they stopped working if they could prove they had been disabled when they stopped working.

After their stroke, when our client quit working the first time their employer’s life insurance policy was with Jefferson Pilot. In the months before our client came back and attempted to work, their employer switched to a life insurance policy with Sun Life. Our client then tried to work for a few months but failed. Our client applied to keep their life insurance because they were disabled when they quit working. Jefferson Pilot denied the coverage saying that our client had come back to work after their policy ended, and therefore did not remain “totally disabled.” Sun Life also denied coverage saying that because our client could not fully perform their job when they tried to come back, they were not “actively at work” enough to be covered by their policy.

After we sued, the court ultimately held that because our client did not fully return to work, they were not “gainfully employed” enough to not be “totally disabled.” Unfortunately, by that time our client had passed away, but we were able to obtain the life insurance benefits for their widow though our success in this case.

To learn more about Our Client v. Sun Life Assurance Company, see more.

ERISA, back pain, ERISA appeal deadlines, ERISA regulations:

Our Client v. Metropolitan Life Insurance Company
United States District Court for the Middle District of Tennessee (2009)

Our client, the plaintiff, worked as a sales representative for Georgia-Pacific until October 2002 when they had to stop working because of chronic lower back pain. Our client applied for and was awarded long term disability benefits starting March 8, 2003. Two years later, MetLife wrote the plaintiff to let them know their benefits were being terminated. The letter from MetLife gave the plaintiff 60 days to respond in writing and request a review of their claim denial. The plaintiff wrote MetLife in May 2003 and was told the denial of their claim was final.

The plaintiff hired us in December 2005, and we helped them obtain updated medical information, and tried to get MetLife to consider that information. After MetLife refused to consider the new information, we sued MetLife under ERISA, and the court agreed with us that when MetLife instructed the plaintiff that an appeal of their benefits termination was to be filed within 60 days, rather than 180 days, as required by ERISA, MetLife committed “a serious procedural error.” The court then remanded the case to MetLife for a full and fair review of the plaintiff’s claim.

To learn more about Our Client v. Metropolitan Life Insurance Company, see more.

Subdural hematoma & outright award of benefits:

Our Client v. Greater Georgia Life Insurance Company
United States District Court for the Eastern District of Tennessee (2009)

Our client was insured under a long-term disability plan offered and administered by Greater Georgia Life Insurance Company (GGLC). The court ruled that GGLC was arbitrary and capricious, or unreasonable, in denying our client benefits. GGLC had no substantive evidence that an alleged pre-existing condition of chronic alcoholism caused or contributed to our client’s disability of subdural hematoma.

Our client was an officer for a non-profit organization and suffered a subdural hematoma, which is usually associated with a severe head injury, after falling several times and hitting his head. He applied for long-term disability (“LTD”) benefits with Greater Georgia Life Insurance Company (“GGCL”), but was denied pursuant to a pre-existing condition provision in his LTD policy.

We brought suit against GGLC on behalf of our client, arguing that there was no pre-existing condition that warranted a denial of benefits.  Although we argued this was a church plan, the court ruled that the benefits were offered through work and that the case fell under the Employee Retirement Income Security Act of 1974 (“ERISA”).

We argued that GGLC’s decision to deny the claim was not only wrong, but unreasonable (which is the test in many cases under ERISA).  An internal nurse for GGLC reviewed our client’s file and concluded that, among other things, that there may be evidence that our client suffered from alcoholism, which may have caused him to fall and hit his head. Subsequently, one of GGLC’s case managers wrote an email explaining that there was not evidence of alcohol use by our client during the relevant time period for a pre-existing condition. Despite these findings, GGLC nonetheless denied our client’s claim, concluding that a pre-existing condition of “chronic alcoholism” caused his disability, and therefore he was not entitled to benefits. Our client appealed the decision, but was unsuccessful in his appeal.

After hearing our case, the court ruled that GGLC acted arbitrarily and capriciously, or unreasonably, in reviewing our client’s claim and awarded him benefits under the policy.  GGLC was unreasonable because it used vague suggestions of chronic alcoholism without defining it or providing evidence that our client’s disability was caused by chronic alcoholism. The circumstances surrounding our client’s fall were never explained by GGCL and there was no investigation into his alleged pre-existing alcoholism.

To learn more about Our Client v. Greater Georgia Life Insurance Company, see more

Fibromyalgia & chronic pain; MetLife order to reconsider denial:

Our Client v. Their Employer’s Plan with MetLife
United States District Court for the Middle District of Tennessee (2006)

Our client contracted Parvovirus B19 infection and developed fibromyalgia, chronic fatigue, anxiety, depression, and insomnia. These debilitating illnesses rendered them unable to perform even sedentary work, much less continue in their career as a store manager.

MetLife relied on shaky medical opinions of physicians to terminate their disability benefits, so we stepped in. The court agreed with us that MetLife acted arbitrarily and capriciously in terminating our client’s disability benefits without exercising its right to have them physically examined. And accordingly, the court ordered MetLife to review our client’s claim again.

To learn more about Our Client v. Their Employer’s Plan with MetLife, see more.

Court-awarded attorney’s fees:

Our Client v. Metropolitan Life Insurance Company
United States District Court for the Eastern District of Tennessee (2008)

After arguing the substantive issues of this case in the United States District Court for the Eastern District of Tennessee, the District Court remanded this case to MetLife for a proper decision. The District Court then granted our motion for attorney’s fees in the amount of $16,933.00, including $350 for reimbursement of the client’s court-filing fee.

To learn more about Our Client v. Metropolitan Life Insurance Company, see more.

ERISA, MetLife, limitations on coverage for certain medical conditions, objective testing for back and musculoskeletal conditions:

Our Client v. Metropolitan Life Insurance Company
United States District Court for the Middle District of Tennessee (2008)

Our client suffered from severe back, neck, and shoulder pain. After receiving benefits for two years, Met Life cut off our client’s benefits claiming that their condition was subject to an exception which limited their benefits to two years. We helped our client appeal this denial. The court found that our client’s condition did not fall into the two-year exception and reinstated their benefits. The court also found that MetLife acted arbitrarily by having the consulting doctor only review our client’s file and by not having them undergo the tests suggested by both the consulting doctor and our client’s treating doctors. Finally, the court awarded pre-judgment interest on our client’s lost benefits and attorney’s fees to discourage MetLife from not fulling reviewing other claims.

To learn more about Our Client v. Metropolitan Life Insurance Company, see more

Depression, panic attacks, bipolar disorder:

Our Client v. Bayer Corporation Long Term Disability Plan
United States Court of Appeals for the Sixth Circuit (2008)

Our client, the plaintiff in this case, was a pharmaceutical sales representative for Bayer Corporation until he had to quit working due to depression, panic attacks, and bipolar disorder. Both of our client ’s treating physicians supported that his mental conditions prohibited from returning to work as a pharmaceutical sales representative. However, Bayer relied on the opinions of its hired experts to deny our client’s claim for benefits.

The district court held that this denial was arbitrary and capricious and that our client was entitled to benefits. Bayer appealed, and we pursued our client’s claim to the Sixth Circuit. The Sixth Circuit agreed with us that our client was unable to perform his regular occupation with Bayer and that Bayer’s reliance on the opinions of experts who had never met our client in person was improper when those opinions contradicted the opinions of his treating physicians. The court declared, “Given th[e] obvious shortfall in the analytical framework used by the experts credited by the plan administrator, in conjunction with the numerous factual errors, misunderstandings, and analytical omissions of those persons reviewing the findings of our client’s treating psychiatrists, the administrative record contained no reliable evidence to support the conclusion that [our client] was competent to return to their previous occupation.”

To learn more about Our Client v. Bayer Corporation Long Term Disability Plan, see more.

Fibromyalgia, objective evidence, cherry-picking, duty to have claimant examined, obligation to consider all conditions, obligation to consider side effect of medications:

Our Client v. Metropolitan Life Insurance Company (2007)

We helped our client win ERISA long term disability (“LTD”) benefits because the court agreed with our arguments that MetLife improperly denied our client’s benefits. The court agreed that MetLife relied only on the evidence that supported its decisions to deny long term disability to our client and ignored other documents that supported our client’s claim.

Our client claimed disability due to fibromyalgia, chronic pain, and other conditions, including mental health issues. MetLife denied our client, saying there was not enough “objective evidence” of disability, relying only on doctors they hired to review medical records.

The court agreed with our arguments that MetLife was not only wrong, but was arbitrary and capricious for relying only on doctors it hired, who did not examine the claimant, yet they decided our claimant’s pain and limitations were not believable. MetLife was also arbitrary and capricious for failing to take into account the opinions of the doctors who actually examined and treated the claimant, for failing to take into account the effects of their medications, and for failing to consider all their medical conditions.

To learn more about Our Client v. Metropolitan Life Insurance Company, see more

Depression and Anxiety:

Our Client v. Metropolitan Life Insurance Company
United States District Court for the Eastern District of Tennessee (2007)

Our client became disabled from depression and anxiety while working at USEC’s Paducah Gaseous Diffusion Plant as a health physics technician. Throughout the administrative appeals process, MetLife, USEC’s claims administrator, denied our client’s claim for long term disability benefits on the basis that their medical records did not contain specific medical tests that evidenced their depression and anxiety. However, the court held that MetLife had acted arbitrarily and capriciously by incorrectly placing the burden on our client to prove their disability of mental illness when the plan required MetLife to ask our client for whatever information (such as specific medical tests) they needed.

To learn more about Our Client v. Metropolitan Life Insurance Company, see more.

Back injury:

Our Client v. Life Insurance Company of North America
United States Court of Appeals for the Sixth Circuit (2007)

Our client, an insurance claims adjuster for ACE Insurance, became disabled from a back injury after working for ACE for twenty-one years.  Throughout the administrative appeals process, Life Insurance Company of America (LINA), ACE’s claims administrator, denied our client’s claim on the basis that her medical records did not contain sufficient evidence of her functional limitations to meet the definition of “disability” in the long term disability plan.  However, the court held that LINA had acted arbitrarily and capriciously by ignoring the notes and tests provided by her treating physicians that did limit our client’s functional abilities and by instead crediting the opinions of hired file reviewers who never discussed our client’s condition with their treating physicians and unreasonably discredited medical evidence supporting our client’s disability.

To learn more about Our Client v. Life Insurance Company of North America, see more.

ERISA discovery, ERISA conflict of interest, courts should take into account the bias when insurance companies use doctors who will favor the insurance company:

Our Client v. Metropolitan Life Insurance Company (2006)
United States District Court for the Eastern District of Tennessee

We were successful in our arguments that we should be allowed to obtain information about how often MetLife used the same doctors over and over to provide opinions to help MetLife deny claims. We also sought information about how much MetLife paid those doctors (or the company that hired the doctors).

The court allowed us to ask these questions, called “discovery,” which was significant, because this was an ERISA case, and such discovery is not always permitted. Usually, discovery in ERISA cases is limited to the administrative record. However, here, the court recognized a limited exception involving certain challenges, such as bias, conflict of interest, or denial of due process.

Dr. Porter reviewed her medical file for MetLife. The discovery questions sought information regarding the relationship between MetLife and the doctor, as well as the money he was paid.

The court allowed the discovery because we showed the court that MetLife had a habit of using the same doctors over and over again, and those doctors were paid well. One of the doctors who reviewed our client’s file for MetLife, Dr. Porter, the president and CEO of Network Medical Review Company (“NMR”), contracted with MetLife for over $500,000 for reviewing 850 medical files. In addition, we drew the court’s attention to the fact that the Seventh Circuit noted that MetLife used NMR extensively. The court agreed with us and compelled Dr. Porter to answer discovery questions.

To learn more about Our Client v. Metropolitan Life Insurance Company, see more.

Ulcerative colitis, frequent diarrhea, bowel disease, Crohn’s disease:

Our Client v. Bridgestone/Firestone Long Term Disability Benefits Plan
United States District Court for the Eastern District of Tennessee (2005)
Our client, the plaintiff, had to stop working at Bridgestone due to ulcerative colitis and frequent diarrhea and was awarded benefits under Bridgestone’s self-funded and self-administered LTD plan.  A self-funded and self-administered plan is one in which Bridgestone itself decided which employees were disabled, and paid benefits out of company funds.

During the first two years of benefits, while the plaintiff only had to be disabled from their own occupation, they underwent a total proctocolectomy and ileostomy.  After Bridgestone paid benefits for two years, Bridgestone asked for updated records and received disabling opinions from the plaintiff’s treating doctors.  A committee at Bridgestone then denied their ongoing benefits based on a verbal report to the committee by a doctor hired by Bridgestone.

We sued Bridgestone on behalf of our client under ERISA, and ultimately the court agreed with us that it was arbitrary and capricious to deny benefits based only on the verbal report of one doctor when all the other doctors supported disability.

To learn more about Our Client v. Bridgestone/Firestone Long Term Disability Benefits Plan case, see more.

Fibromyalgia & Osteoarthritis:

Our Client v. BWXT Y-12, LLC
United States District Court for the Eastern District of Tennessee (2005)

Our client, an accounting support specialist at Lockheed Martin, became disabled due to the chronic pain and fatigue caused by fibromyalgia and osteoarthritis. Once they had been disabled for two years, they had to prove they were disabled from any occupation.  At that point, MetLife, the insurance company for their employer, denied the claim based on the opinion of a doctor who only reviewed our client’s medical records.  The court agreed with our arguments and found MetLife was arbitrary and capricious for ignoring the opinions of doctors who actually examined and treated our client, and also for ignoring the finding by the Social Security Administration that they were totally disabled.

To learn more about Our Client v. BWXT Y-12, see more.

Avascular necrosis (AVN), hip replacement:

Our Client v. Aetna Life Insurance Company
United States District Court for the Eastern District of Tennessee (2005)

Our client, the plaintiff, was disabled due to avascular necrosis (AVN) in their hips, but their claim was denied by Aetna.  Aetna claimed that our client’s AVN was related to a different medical condition that was preexisting, and not covered under the policy, and therefore the AVN was not covered because it was “related to the preexisting condition.”  Later the plaintiff had a hip replacement because of the AVN, and Aetna continued to claim it was related to a preexisting condition, but even if it were not, it would not be totally disabling.

Aetna attempted to rely on one or two of its own doctors while ignoring even other doctors Aetna had hired, as well as treating doctors.  The court ultimately agreed with us that the plaintiff was entitled to benefits.

To learn more about Our Client v. Aetna Life Insurance Company, see more.

Denial overturned and remanded.  Insurance company was arbitrary and capricious:

Improper bias, procedural challenges, & granted discovery request