Case Story: Our client v. Metropolitan Life Insurance Company
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.
Our client 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 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.
On June 24, 2002, MetLife awarded our client long term disability benefits. As required by the plan, our client pursued a claim of disability with the Social Security Administration (SSA) and was awarded total disability by the SSA in early 2003. Id. Then, in April 2004, MetLife awarded our client phase two benefits — those awarded if a claimant is unable to perform any job. Id. On October 4, 2005, our client was notified that MetLife was terminating their benefits effective August 31, 2005. Id. Our client appealed the denial of their benefits directly to MetLife, and they issued them two denial letters, the last one on December 20, 2005. Id. After that, we helped file an ERISA complaint in district court for wrongful denial of benefits, and, in 2007, the court remanded the case back to MetLife for a full and fair review. Id. On remand, MetLife denied our client their disability benefits, and, in 2011, we helped bring this second ERISA action following the termination of their disability benefits. Id.
The court noted that “the problems which the District Court found pervaded MetLife’s decision [to deny our client’s disability benefits] prior to remand continue to pervade MetLife’s decision after remand.” The plan required that “in order to receive continuing benefits, [our client] must furnish periodic medical evidence of [their] illness or injury if requested by the Company.” (emphasis added). It was not up to our client to provide MetLife with specific medical tests or information unless requested to do so. Even after remand, MetLife continued to blame our client for not providing information to them that, they said, would provide evidence of our client’s condition. Id.
Shortly after MetLife’s original termination of our client’s benefits, the plaintiff moved with their family from Kentucky to Tennessee and changed their mental health provider from Dr. Meyer to Dr. Tim Larson with Behavioral Health Associates. They also went to Kathy Scott, a certified clinical social worker, at the suggestion of Dr. Larson. The purpose of this therapy was to address anxiety and stress. Id. Our client also saw Dr. Sandra Kilpatrick, a licensed clinical psychologist, who diagnosed them with Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder with Agoraphobia, Obsessive-Compulsive Disorder, and Post-Traumatic Stress Disorder. Id. at 5. When Dr. Kilpatrick met with our client, the psychologist opined that “[g]iven the severity of their depression, their anxiety, and the agoraphobia, it is not likely that their ability to sustain consistent work will change in the foreseeable future.”
The court agreed with us and found in favor of the plaintiff. The court found that MetLife’s decision to deny our client’s long term disability benefits was indeed arbitrary and capricious. The court noted that MetLife continued to fault our client for not providing objective evidence and specific types of tests when objective evidence was not usually available for our client’s type of illness. Id. Before stating that MetLife’s decision to terminate our client’s benefits should be reversed and that their disability benefits under the plan should be awarded, the court observed that MetLife could not go back in time and perform tests on the plaintiff, and any further testing would not be of value. Id.
