Fibromyalgia Claimant Wins MetLife Disability Insurance Lawsuit

MetLife determined a disability claimant with Fibromyalgia was not disabled after two years of receiving benefits, but a California Federal Judge disagreed. Federal courts in California have stood behind employees and forced insurance companies to pay disability benefits. We want to be your California disability attorney and make the disability insurance company pay your benefits. The law governing disability insurance claims is complex and often skewed in favor of the insurance company. Let’s take a look at a court decision in which a California Federal Judge reversed a MetLife disability denial.

MetLife is Ordered to Pay Disability Insurance Benefit

In Lavino v. Metropolitan Life Insurance Company, a federal court in California found that the insurer had abused its discretion in denying long-term disability benefits under an ERISA plan. The plaintiff had been a civil project engineer for ten years. However, she sought medical leave and disability benefits in 2005 due to chronic pain and fatigue linked to fibromyalgia. After paying benefits for nearly two years, the definition of disability changed from own occupation to any occupation. The claimant was forced to return to work – even though her condition had not improved and her doctor still considered her unable to perform any work.

MetLife Denial of Long Term Disability Benefits Includes Numerous Mistakes

When the plaintiff sued to recover the disability benefits, she pointed to procedural and substantive mistakes in the way MetLife processed the claim, including:

The California federal court found that MetLife had abused its discretion in denying the benefits. The court recognized that, although the plan gave MetLife discretion, that discretion has limits. Sometimes a searching inquiry is required and this was one of those instances. MetLife decided who got benefits and Metlife was also responsible for paying those benefits. This necessarily created what the court described as a structural conflict of interest. With a financial incentive to deny coverage, the court refused to overlook the unreasonable and arbitrary manner in which MetLife denied benefits. These actions cast doubt on MetLife’s ultimate conclusion. The court’s skepticism led it to find that MetLife’s denial of long-term disability benefits could not be sustained and ordered MetLife to reinstate benefits.

Lavino v. Metropolitan Life Ins. Co., 779 F. Supp.2d 1095 (C.D. Cal. 2011).

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What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

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No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

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When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Josh C.

After suffering with the symptoms of ME/CFS for nearly 3 years, I was finally diagnosed with ME/CFS in August of 2011. I filed a claim and was approved by my disability insurance carrier initially. After a little over one year of not working, I started seeing some minor improvement. I told my doctor about the improvement and my carrier took that as news that I was now ready to return to work, which was far from the truth. My doctor told me not to go back to work yet, knowing it would only set me back and reverse my progress. My insurance carrier did not care and they made me attempt work. If I didn’t follow their rules they were going to drop me. I had no idea what to do or what my rights were in my disability contract. I called Greg Dell.

Greg gave me great advice. He spent a great deal of time on the phone with me answering all my questions, explaining all my options and recommending the best course of action. He was able to explain things to them that just made sense. I have been working with him for well over a year. He could articulate what I and my doctors were saying that I was not able to on my own. Anyone with ME/CFS knows how incredibly hard and difficult it is to try and explain your symptoms and limitations to someone.

Greg actually gets it and is who you want in your corner when you’re dealing with an insurance company that is not your friend. Greg was able to get me back on total disability with no work requirement. Unfortunately the work I had to do for those months in between did set me way back in my recovery, but that only makes me wish I had gone with Greg from the get go instead of waiting for a crisis that could have been prevented.

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