Legal Summary: Bradford v. Metropolitan Life Insurance Company

No. 3:05-CV-240, 2007 WL 956640, (E.D. Tenn. Mar. 29, 2007) (memorandum opinion granting plaintiff’s motion for judgment on the pleadings)

514 F. Supp. 2d 1024 (E.D. Tenn. 2007) (memorandum opinion granting plaintiff’s motion for collateral benefits she was due under the plan.)

In the order finding the claimant disabled the court listed several things MetLife did wrong. In Bradford v. Metro. Life Ins. Co., No. 3:05-CV-240, 2007 WL 956640, at *11-12 (E.D. Tenn. Mar. 29, 2007).

MetLife only relied on doctors who reviewed the medical records and did not examine the claimant.  The court explained, “the Sixth Circuit has held that ‘the failure to conduct a physical examination-especially where the right to do so is specifically reserved in the plan-may, in some cases, raise questions about the thoroughness and accuracy of the benefits determination.’ ” Id., at 11, citing Calvert v. Firstar Fin., Inc., 409 F.3d 286, 289 (6th Cir. 2005).  Because MetLife’s doctors asserted the claimant’s pain was out of proportion to her objective findings, thus finding her pain was not credible, the court went on to explain, “a decision not to exercise the option to have an independent examination is placed under heightened scrutiny when a file reviewing physician makes credibility determinations about a claimant’s subjective complaints.” Bradford, 2007 WL 956640, at *11, citing Smith v. Cont’l Cas. Co., 450 F.3d 253, 263 (6th Cir.2006).  Further, MetLife’s doctors downplayed the effects of the claimant’s medications, so the court explained, “the Smith court also indicated that an administrator’s failure to take into account the effects a claimant’s medication had on the claimant’s ability to work is another factor that should be considered when making the arbitrary and capricious analysis.”  Bradford, 2007 WL 956640, at *11, citing Smith, 450 F.3d at 265.

The court also had problems with the way MetLife rejected the opinions of the treating doctors.

Although a plan administrator is not required to give special deference to plaintiff’s treating physicians, nor may an administrator arbitrarily rely on one of its own consultants in the face of all other contrary evidence. See Spangler v. Lockheed Martin Energy Sys., Inc., 313 F.3d 356, 362 (6th Cir.2002) (insurance company acted arbitrarily in relying on one report from physician instead of entire file); Williams v. International Paper Co., 227 F.3d 706, 713 (6th Cir.2000) (administrator’s decision not to consider all of the medical evidence was arbitrary and capricious).

Bradford, 2007 WL 956640, at *11.  The court also noted MetLife failed to properly consider all of the claimant’s medical conditions.  Id.  All of this supported the finding that the claimant was totally disabled under the plan. Id., at 12.

After the court found our client disabled the court considered what benefits our client was entitled to and issued another opinion.  Bradford v. Metropolitan Life Ins. Co., 514 F.Supp.2d 1024, 1026 (E.D. Tenn. 2007). We argued that our client should get all the benefits that were “tied to” her LTD benefits, also called “collateral” benefits.  We also argued that our client should be put in the position she would have been if she had been properly paid her LTD the whole time, which would include interest on her benefits, and also allow her to undo any retirement or pension elections she had made because her LTD was denied.

The first issue the court addressed was whether the claimant should be paid all of her back LTD benefits through the date of the decision.  Id., at 1029.  MetLife argued that during the time her claim was denied, the definition of disability changed from “own occupation” to “any occupation” after 24 months and that MetLife had not yet considered her “any occupation” claim.  The court ruled that because it was MetLife’s own fault benefits were wrongfully denied, benefits should be paid through the court’s judgment.  The court explained:

The Sixth Circuit has held that “where the review of the medical evidence was arbitrary and capricious or unreasonable, the proper remedy is to retroactively grant benefits without remand.” Williams v. International Paper Co., 227 F.3d 706, 715 (6th Cir.2000). The Williams court went so far as to order retroactive benefits beyond the scope of the administrative record. Id. at 715-16.

The Court has already found that, based upon the record, Plaintiff is disabled, and the Court also found that Defendants acted arbitrarily and capriciously in denying Plaintiff’s claim for LTD benefits. In light of these rulings, the Court finds that the appropriate remedy is to award Plaintiff retroactive benefits through the date of the entry of final judgment. It was Defendant who erred in denying Plaintiff’s claim, and Defendant should bear the burden of that error.

Bradford, 514 F. Supp. 2d at. 1029.  Of course, going forward, MetLife may evaluate whether the claimant could do other employment, but all possible back pay would be paid. Id.

In addition to the money paid directly under the LTD plan, someone who is disabled under the plan would be allowed to continue her medical and dental coverage as if she were still employed, could continue her life insurance without paying premiums and could continue to earn pension credits. Id. at 1030. MetLife and the Plan argued that these benefits were “consequential damages,” or damages over and above her benefits due under the plan, which are not available under ERISA.  The court did not agree, explaining that these are the type of benefits that an employee can recover when she sues for LTD benefits if, like in this case, those are benefits that are due under the terms of the plan.  A “[p]laintiff should not be denied any benefits available under the Plan because of Defendant’s error.” Id.

The court ordered reimbursement of extra health and life insurance premiums she paid, and ordered her life insurance reinstated at the level it would be for someone on LTD. Id.  On top of that, because MetLife denied the LTD claim, the claimant was forced her to take an early retirement pension so that she could maintain her health insurance, which charged higher premiums than her pre-disability plan. Id. at 1029. The court said that pension election could be undone, and the plaintiff could pay back her pension benefits, so that she would be put in the position she would have been had she been paid the LTD and had not had to take out her pension. Id., at 1030.

Finally, we successfully fought for pre-judgment interest.  Recognizing she was forced to go without the disability payments she was entitled to during the litigation process, the court awarded pre-judgment interest at the rate used in one year treasury bills, which is similar to the rate used for post judgment interest, which the court also awarded.

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