MetLife agrees to overturn its denial of long term disability benefits for Florida Doctor after an ERISA appeal filed by Alex Palamara
Author: Attorney Alex Palamara
A Florida Anesthesiologist contacted our office after being denied long term disability benefits by MetLife. Prior to making a claim for such benefits, our client had worked as an Anesthesiologist since the early 1980’s. Unfortunately for our client, she began suffering from various health conditions which left her unable to engage in her regular occupation. Her conditions included: Left Shoulder Arthritis, Osteoarthritis of the Left Shoulder, AC Joint Arthritis, Left Ulnar Neuropathy, Ulnar Nerve Lesion, Left Wrist Carpal Tunnel Syndrome, Cubital Tunnel Syndrome, Right 5th Finger Phalanx Fracture, Fatigue, Essential Hypertension, Osteopenia, Hypothyroidism, Chronic Migraines, Esophageal Reflux, Vitamin D Deficiency and Hyperlipidemia.
Fortunately for our client, she had purchased a long term disability policy in 1987 for this very situation so that she would be paid a benefit should she be unable to continue working due to disabling medical conditions. Shortly after stopping work in September of 2013, our client made a claim under the aforementioned policy that she had paid premiums on for 26+ years. Unfortunately for our client, after paying benefits for less than one month under a “reservation of rights”, MetLife denied her claim and stated that it had determined that she was able “to perform the duties of your occupation.” As such, MetLife denied her claim and refused to pay any further long term disability benefits.
While dejected due to MetLife’s obvious incorrect determination, our client realized that MetLife’s decision was incorrect and something had to be done about it. Within days of receiving the June 27, 2014 denial letter, the Florida Anesthesiologist found Attorney Alexander Palamara to assist her with her claim for long term disability benefits.
Alexander Palamara of Dell & Schaefer Gets Involved
Attorney Palamara quickly reviewed the denial letter and relevant medical records provided from his now client. After this review, it was obvious that MetLife’s decision was blatantly wrong and that the Florida Anesthesiologist should be on claim receiving long term disability benefits.
Review of the Claim and the Filing of the Administrative Appeal
After receiving and reviewing all the files from MetLife and all relevant medical records from the client’s treating physicians, Attorney Palamara could see that the in-house internal reviews MetLife relied upon were biased to the point of having no reliability whatsoever. An appeal was quickly filed that both challenge MetLife’s internal reviews and focused on the objective medical evidence that easily proved that our client could not, in no way, shape or form, perform the duties of her own occupation.
MetLife Overturns Its Incorrect Decision
By way of a letter dated August 3, 2015, we received word that MetLife had completed its review of our client’s appeal for Individual Disability Benefits. MetLife informed us that it now found that our client’s “claim of Total Disability beginning September 13, 2013 to be supported at this time.” As such, our client will now thus be paid her rightfully owed long term disability benefits and MetLife will be paying all past due benefits previously owed.
While we are so happy for this fantastic outcome, our client knows that the fight continues. Fortunately, our client rests assured because she knows that Attorney Palamara and Dell & Schaefer will continue to do whatever it takes to see that she remains on claim until she is able and ready to return to work or until her policy expires.
If you have been denied disability benefits by MetLife or any other disability insurance company, please do not hesitate to contact Attorney Alexander Palamara at Dell & Schafer for a free consultation.