GE Benefit Denial Overturned For Plaintiff with Permanent Loss of Function of His Foot

In Stockman v. GE Life, Disability and Medical Plan et al., the plaintiff severely injured his foot and totally lost the function of it for 12 months. He then applied for benefits under the GE Life policy claiming he suffered a “total and permanent” loss of the use of his foot. MetLife, Plan Administrator for GE, denied his claim on the grounds that the loss was not total and permanent. Both the Ohio district court and appellate courts disagreed with MetLife. The appellate court concluded: “If Stockman’s injury, which has resulted in the ‘permanent’ loss of the use of his foot in the way that a foot should be used does not qualify him to receive benefits, we are unsure of a situation, absent actual severance, where a claimant would qualify.”

Brief History of the Case

In 2009, Steven Stockman severely injured his foot when he fell off a second story ladder. Subsequently, he underwent seven separate surgical procedures and contracted several infections that required extensive treatment. After 12 months of total loss of the use of his foot, he applied for benefits under the policy that covered accidental dismemberment with the definition of dismemberment being the “permanent and total loss of function of the hand or foot as a result of an accident after the loss has continued for at least 12 consecutive months.” The plan denied him benefits and after he exhausted his administrative appeals, he filed a lawsuit under the provisions of ERISA.

MetLife did not dispute the fact that Stockman had lost the function of his foot for 12 consecutive months as required by the plan, but argued the loss of function was not total and permanent since, after the expiration of the 12 months, he was able to walk with a cane. In court, the resolution of the case depended on the definition of the word “permanent”.

MetLife argued that “permanent” means there will never be any improvement, and since the condition of Stockman’s foot had improved after the 12 month eligibility period to the extent that he could occasionally walk without a cane, his injury was not permanent. Stockman argued that the dictionary definition of permanent should be used which describes something as permanent when it is “enduring without fundamental or marked change.”

The Court’s Final Decision

The district court agreed with Stockman and stated that the “mere fact that his foot is still attached to his body” is not enough to decide the foot is functional. The appellate court agreed with the district court and concluded that if MetLife’s definition of permanent were followed, it would be superfluous. No claimant whose foot had not been severed would ever be able to collect benefits. That court agreed with the district court’s conclusion that Stockman was entitled to benefits since “the plan allowed for benefits when a person has suffered an injury that, for all intents and purposes, has resulted in the loss of the use of the foot to the point where it no longer serves the purpose it was intended to serve and will never be able to serve that purpose.” Since Stockman’s medical records supported that definition, the district court determined he was entitled to benefits and the Court of Appeals for the Sixth Circuit agreed.

This case was not handled by our office, but it may provide claimants guidance in their pursuit of compensation under the accidental dismemberment clause of an insurance policy. If you need assistance with a similar matter please contact any of our lawyers for a free consultation.

Leave a comment or ask us a question

Questions About Hiring Us

Do you help MetLife claimants nationwide?

We represent MetLife clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a MetLife disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from MetLife. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by MetLife.

How do you help MetLife claimants?

Our lawyers help individuals that have either purchased a MetLife long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with MetLife:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

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.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

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.

How can I contact you?

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   *****

Steven W.

“Whatever it Takes”, and you can take that to the bank, as I did. I was declared disabled in March 2010 after unsuccessful Back surgeries, CSC Implants, numerous other treatments, all which failed. I was (and still am) in constant pain requiring medication therapy and managment. June 2012, after receiving my benefit for 18 months I received a letter from my CIGNA case worker stating I no longer meet the contract definition of Disability. Therefore they stopped my benefit immediately. My numerous attempts at trying to resolve my Reinstatement Request was bogged down with hidden agendas, request for test after test, loosing documents from critical doctors supporting my claim, never returning my calls.

I contacted Dell & Schaefer, Alex Palamara, for a free consultation. He replied the same day. We spoke briefly and set an appointment the following day to pass detailed information. I faxed to him all supporting documents. In the beginning I was sceptical. But after a few weeks I could sense that they were a no BS organisation. I began to feel like they were really working hard for me. Throught the somewhat long process I was very impressed with the way they handled my case. They kept me informed of all issues via Email or calls. Never, never, did Alex (Mr. Palamara) or any of his staff fail to reply within 24 hours and usually within the same day to any of my request. I can’t say enough about the professionalism, courtesy, care, with the way they handled my case. My long hours of research have lead me to believe that Dell & Schaefer are by far the LTD hardest working informed agency out there. And, they would prove me right: as just recently I received a letter from Alex Palamara, forwarded from CIGNA stating a full reversal of my claim to begin immediately with full back pay and monthly benefits.

I cannot thank Alex and his staff enough for the fight they must have endured from CIGNA’s attorneys.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us