In a case recently decided by an Arkansas Federal Court, MetLife prevailed in a lawsuit filed by an Eastman Chemical Company Employee. Ultimately, due to video surveillance, a lack of medical support, and the fact that the claimant had continued working at a side job (of which he had failed to inform MetLife of) while claiming to be disabled, the Court, it seems, had no choice but to agree with MetLife’s decision to deny Long Term Disability Benefits.
The fact that the claimant provided no evidence that he was still disabled from November 2009 until the time of the Court’s order, the Court had little option but to declare that Met Life “did not abuse its discretion in terminating [Freddie M.’s] benefits.” For educational purposes, let’s take a closer look at this case involving MetLife and why the claimant was unsuccessful:
Maintenance Mechanic Became Disabled in 2006
Freddie M. began working for Eastman Chemical Company as a maintenance mechanic in 1992. His job duties were that he was “‘responsible for mechanical repair of all equipment plantwide until 2004.'” Later, Freddie M. was transferred to the fork truck shop, where he worked moving large pieces of stock. In August 2006, Freddie M. took sick leave from the company and filed a MetLife Disability Application for long-term disability benefits per his Eastman Long-Term Disability Plan. Freddie M. was unable to work because of “an abnormal ENG test with 81% weakness of the right vestibular nerve”; a maximum of 20% weakness is allowable for normal functionality. Stating that he was unable to work due to “unsteadiness/dizziness,” Freddie M. continued to drive, walk, read, and take care of his household.
Upon evaluation of Freddie M.’s medical records, Met Life found that while Freddie had complained of dizziness in May 2006 to his physician that Freddie M.’s physician indicated that by July 12, 2006, due to treatment of the condition, Freddie M.’s dizziness had improved. However, Freddie continued to suffer “from loss of balance when walking or turning,” but that Freddie M.’s MRI “revealed normal internal auditory canals and normal brain condition.” Complaining that his dizziness had, in fact, worsened just two weeks after this MRI, Freddie M. had another ENG performed, which did show an 80% weakness of the right vestibular nerve. Freddie M. was cautioned not to climb ladders or engage in activities where his safety was jeopardized by his lack of normal balance. Freddie M.’s physician stated that Freddie M. could not return to work “unless he could be cleared one hundred percent with no restrictions” so Freddie M. did not return to work. The physician filled out a physician statement that confirmed his finding that Freddie M. could not return to work. Consequently, Met Life approved Freddie M.’s disability benefits application, but told Freddie M. they would require periodic updates of his medical condition.
After the awarding of benefits, Freddie M. returned to his doctor, complaining of headaches and was referred to a second physician who stated in a January 31, 2007 letter that Freddie M.”suffered from dizziness orthostasis, vertiginous symptoms, and difficulty orienting in space, and that these ailments would likely not improve and did interfere with his ability to work.” Later on February 15, 2008, Freddie M. had another ENG which showed 100% caloric weakness in his right ear, meaning his condition had worsened, or essentially, had not improved so as to allow Freddie M. to return to work. In March 2009, Freddie M. was diagnosed with severe depression and anxiety and prescribed anti depressants.
Met Life Discovers that Claimant is Working Part Time
Upon receipt of an anonymous letter forwarded to Met Life by Eastman that claimed that Freddie M. was working part time as a certified assembly tester, the insurer set up video surveillance of Freddie M. to check out the validity of the letter’s message. MetLife investigators made contact with Freddie M. to verify their findings, and Freddie M. admitted that he had begun RPZ testing and repair as a side job a couple of years before he left Eastman Chemical and continued to take projects on from time to time.
MetLife had Freddie M.’s medical records sent to a certified otolaryngologist who stated that in his opinion that he found no objective findings upon a physical examination of Freddie M.”that support the need of restrictions and limitations in work activities” after August 27, 2009. With no medical records attesting to Freddie M. suffering from vertigo and the other symptoms he previously had displayed since March 2008, the reviewer stated that Freddie M. was not disabled. This opinion was passed along to Freddie M.’s primary physician, who opined that Freddie M.’s depression and anxiety were disabling, but did not mention Freddie’s vertigo or vestibular nerve weakness.
Met Life Terminates Claimant’s Benefits and District Court Affirms that Decision
Based on the evidence available, MetLife terminated Freddie M.’s disability benefits. Freddie M. appealed, and MetLife had his file reviewed by another MetLife certified otolaryngolist, who supported the termination saying that there was no evidence that Freddie M. had “any functional limitation beyond November 19, 2009.” Pointing out that the body often can compensate when balancing mechanisms are challenged, this second otolaryngolist determined that Freddie M.’s condition had stabilized on its own over time. To take the process one step further, MetLife also had a psychiatrist review Freddie M.’s medical records and it was determined that Freddie M. was responding “nicely” to antidepressants and was currently psychiatrically stable.
Mounting a full press attack by alleging that Met Life abused its power of discretion in terminating Freddie M.’s disability benefits, Freddie M. and his Arkansas disability attorney were unable to convince the District Court that the insurer’s termination of his disability benefits was without merit. The Court summed up its long memorandum affirming Met Life’s decision to terminate Freddie M.’s disability benefits by stating that “other than [his own doctor’s] statements that [Freddie M.’s] conditions were ‘permanent,'[Freddie M. and his Arkansas disability attorney] presented no evidence tending to establish that he was still disabled in November of 2009. Indeed,[Freddie M.] was working part-time as a repair mechanic. The evidence established that [Freddie M.’s] condition had improved to the point that he was no longer disabled. Therefore, MetLife did not abuse its discretion in terminating his benefits.