Court Orders Metlife to Re-evaluate the Denial of Disability Benefits to Citibank Employee

In Reed v. Citicorp and Metropolitan Life Insurance Company of America, the Third Circuit appellate court did not rule on the merits of plaintiff Frank Reed’s claim that MetLife, Plan Administrator for Citigroup, erred in terminating his long term disability benefits. However, the court did find that the New Jersey District Court erred in granting MetLife’s summary judgment on two major issues raised by Reed. It remanded to the District Court for further proceedings consistent with the unpublished appellate court decision.

The appellate court noted that the procedural history and facts of the case were presented in detail in the district court record it was reviewing, so it would not recite them in the appellate opinion. It did not mention what Reed’s job had been. The only mention of his disabling condition was the phrase, “Reed fell and injured himself on April 9, 2008, at a company-related event. He did not return to work thereafter.”

Reed was initially given salary continuation benefits and then long term disability benefits from the date of his fall until November 3, 2009, when MetLife sent him a letter telling him his disability benefits were being terminated. The reason given was that Reed had not received appropriate medical care and treatment as required by the policy. Reed exhausted his administrative appeals and then filed an ERISA lawsuit in a federal New Jersey District Court. The District Court granted MetLife’s motion for summary judgment on all issues raised by Reed. The appellate court remanded to the district court for further proceedings on two issues.

Evidence of Conflict of Interest Due to MetLife’s Monetary Concerns

Reed alleged that MetLife had a structural conflict of interest based on monetary concerns. This led it to deny his claim in order for MetLife to save money without considering his disability claim on the merits. The district court agreed with MetLife, but the appellate court did not.

The Third Circuit found that Reed pointed to evidence that raised a reasonable inference that MetLife made its “decision based on monetary concerns, rather than the merits of Reed’s claim, after learning that it had been underpaying his claim by approximately $10,000 per month.” Although this was not proof of the conflict, the court found it raised a “reasonable inference that money concerns were a factor.” The appellate court remanded to the district court to reconsider this issue.

MetLife’s Final Letter Terminating Benefits is Unclear as to Why

The November 3, 2009, termination letter indicated benefits were terminated because Reed had not received “appropriate care and treatment” as required by the plan. The January 21, 2011, letter denying Reed’s appeal inferred that benefits were being denied because he no longer met the definition of disability. A final letter dated May 24, 2011, states that independent reviewers determined “the medical information does not support functional impairment to preclude Mr. Reed from performing full-time work beyond November 3, 2009.”

The appellate court held that, on this record, it was impossible to tell why benefits were terminated. If based on the medical information, MetLife needed to clarify what medical information was different from the information it had when it initially awarded benefits and why it was the basis for terminating benefits.

This case was not handled by our law firm, but we believe it can be helpful to those fighting to gain their long term disability benefits but are faced with apparent conflicts of interest with their insurer. For questions about these issues, or any other matter concerning your disability benefits, contact on of our attorneys for a free consultation.

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My illness began slowly, I made adjustments to my work schedule and life schedule hoping that would allow me to stay employed. I didn’t want to give up the money, my benefits, the years experience I had, the value I had to contribute etc… That lasted for about a year and half then suddenly my body just couldn’t do it anymore. My illness exacerbated, necessitating me to leave work. I went out on my STD policy and initially Aetna the carrier of the policy was cooperative and approved my claim. After several months when I didn’t improve my STD policy was over and it was time to begin my LTD. At this point Aetna suddenly switched and began to deny all my claims for the same illness they had previously approved. I was shocked and bewildered, I could not believe how Aetna could be doing such a thing. What was happening, how could they just say NO! This wasn’t fair, I paid into this for 29 years… and was lost as to what to do.

I did some research on line, and found out this was a common thing all insurers were doing to people who had these kind of policies. What a rip off I thought. Here I thought I had a safety net. I was so angry and realised I was disillusioned about this system and having a safety net. I sat and cried fluctuating between anger, sadness, worry, the gamut of feelings. What should I do I thought, I need help and help fast. I couldn’t live without income. I did some more research and found Dell & Schaefer, I went through their website reading all the information and decided I need to call them to see if they could help me. My illness was not listed as a common illness for disability approval.

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I will not give up my representation, as educated as I am, in no way am I versed in disability law and the new ways insurance companies try to get out of paying the policy we have paid our hard earned money into for a safety net. I know things will not be easy and I will have to fight to continue my benefits, having Dell & Schaefer gives me security that someone will be there fighting for me and my benefits. I can’t thank them enough, I find them to be prompt, compassionate, knowledgeable and very fair with their fees. If you are thinking about hiring an attorney for representation you will be pleased with this firm. As a side note, my last years of employment I worked for a large hospital system, my job was coordinating with the hospital, physicians and Insurance companies to make sure the hospital would get paid. Specifically, I worked on denials of patients inpatient hospital bills. The insurance company would deny claims for the most unbelievable reasons. They know some people will just give up and not fight, that’s what they are counting on. I didn’t think they would do the same thing with STD and LTD policies, I was wrong and naive. Do yourself a favour, HIRE an attorney immediately from the beginning, otherwise the carrier will jerk you around till you give up, and you may inadvertently say or fill out a form wrong or miss a date and boom you are denied. You will never get your benefit you paid into. Hire Dell & Schaefer.

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