Court Remands Fibromyalgia Case for Further Consideration after Finding MetLife Failed to Consider FCE Report and Vocational Evaluation

It is extremely common for insurance companies to deny disability benefits when the basis for the claim is the inability to work due to Fibromyalgia. The reason this happens so often is due to the subjective nature of the illness and lack of the existence of objective proof of the illness. Insurance companies notoriously ignore physicians’ opinions that support their patient’s inability to work, since these opinions are based on subjective complaints alone. However, when the claimant is able to provide objective proof of his or her disability such as providing a Functional Capacity Evaluation or Vocational Analysis that demonstrates their inability to work, the insurance company must consider that evidence in its evaluation of the claim.

In the case of Al-Abbas v. Metro. Life Ins. Co., a Massachusetts Court disagreed with MetLife’s decision to deny long term disability benefits to Al-Abbas who developed fibromyalgia after a car accident and could no longer work. The Court found that MetLife abused its discretion by ignoring the results of a functional capacity evaluation which showed the plaintiff put forth full effort and was unable to sustain work on a regular and predictable basis and was therefore disabled. MetLife failed to furnish any reasons for rejecting the FCE test findings, and only briefly mentioned the vocational evaluation by listing it among evidence “reviewed.” In addition, MetLife also completely ignored the Social Security determination that the plaintiff was disabled from any gainful occupation. While the Court’s main focus was the failure to consider objective proof of disability provided by the plaintiff, the Court noted:

When certain illnesses do not “lend themselves to objective clinical findings,” the proper approach is to consider “the physical limitations imposed by the symptoms of such illnesses [that] do lend themselves to objective analysis.” Boardman v. Prudential Ins. Co. of Am., 337 F.3d 9, 17 n. 5 (1st Cir.2003).

MetLife certainly had the discretion to weigh the evidence provided by the claimant, but MetLife’s finding that the plaintiff was not credible, despite there being no suggestion that she was malingering or exaggerating her illness was a major problem for the Court. The Court was also critical of MetLife’s complete dismissal of objective proof of the plaintiff’s disability and therefore remanded the matter to the insurance company for further reconsideration.

Dell & Schaefer Chartered did not represent the Plaintiff in the above matter, however, our attorneys are available to provide a free consultation if you have experienced a denial or have an issue with your disability insurance carrier.

We have a lot of information about fibromyalgia disability claims on this page.

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