Our Client v. Their Employer’s Plan with MetLife
We helped our client get the long term disability benefits that they were entitled to under their plan with MetLife. Our client held a B.B.A. degree in business administration and worked as a store manager before contracting Parvovirus B19 infection and developing fibromyalgia, chronic fatigue, anxiety, depression, and insomnia. These debilitating illnesses rendered them unable to perform even sedentary work, much less their career as store manager.
MetLife initially approved our client’s application for long-term disability, but later terminated their disability benefits because its consulting physicians disagreed with the opinions of our client’s personal physician. In response, our client provided MetLife the opinion of their personal physician, which stated that they were incapable of performing even a sedentary job. Additionally, we consulted a well-qualified vocational expert who confirmed that the limitations observed by our client’s physician did indeed preclude them from any type of job in the national economy. Rather than take these expert opinions into account, MetLife sided with the consultants it had hired.
MetLife’s consultants merely reviewed our client’s medical records and never performed a physical medical evaluation. Because the plan explicitly stated that MetLife had the authority to require our client to submit to such an examination, the court found that MetLife was unreasonable in not requesting such an examination. The court agreed with us that MetLife’s decision-making process was arbitrary and capricious. Taking that into account, along with the obvious conflicts of interest in MetLife relying on its own paid consulting physicians, the court reversed MetLife’s termination of our client’s disability benefits on grounds that its determination was arbitrary and capricious and ordered it to reconsider our client’s claim.