Contracts Manager With Toxic Encephalopathy Wins MetLife Long Term Disability Denial Appeal
Our client came to us after her claim for long term disability insurance benefits was denied by MetLife. Prior to filing this claim, she worked for the Harris Corporation which is now known as L3Harris Technologies, a technology company and defense contractor. In fact, as part of her occupation as a Contracts Manager, she worked on a base in a building that had significant mold issues.
While working, she suffered from chest congestion, violent nose bleeds as well as cognitive issues. Knowing something was wrong, she went to the doctors and was eventually diagnosed with Toxic Encephalopathy, chronic fatigue and chronic pain.
By way of her employment with L3Harris, she was covered under STD and long term disability (LTD) policies. Upon applying for disability benefits her STD claim was quickly approved and it was eventually paid for the full time period. She then applied for disability benefits under the governing LTD policy. She filled out the paperwork and sent in some medical records to prove her claim. Unfortunately, the records which were sufficient to prove her STD claim were not enough to prove the LTD claim. MetLife had unreasonably determined that when Short Term Disability ended and Long Term Disability was to begin that our client miracuously was able to return to work. By way of a disability denial letter, MetLife denied the claim stating that the medical information was not enough to support an inability to return to work.
Metlife will commonly rely upon their own hired doctors and nurses to deny long term disability benefits.
In support of its decision, MetLife relied on its in-house nurse clinician and medical director. Both MetLife employees. These employees did state that while her mold exposure did warrant an ER evaluation and specialist follow up, the records, they believe, did not demonstrate acute respiratory compromise, etc. They even stated “although records indicate you met diagnostic criteria for Chronic Inflammatory Response Syndrome with long term exposure to a water damaged building, no significant exam findings …were noted.”
Following this denial, our client located in Texas found us on the internet and we immediately went to work.
The first thing we did was get the claim file to get all the records MetLife was relying upon which includes the reviews of their employee nurse and medical director. Going through those reviews was the first thing we did to see what those medical employees overlooked or thought was missing from our client’s claim. Next, we got updated records from all of her treating providers so that we can see what was actually in our client’s records. We then reached out to her treating providers to garner more support for this claim. The responses from the actual treating providers in support of disability were overwhelming. We appealed the Metlife disability denial.
With our Metlife ERISA appeal, we showed that MetLife’s medical director assigned to this case was not a physician that specializes in environmental illness. We then contrasted that with some of our client’s treating providers who have studied Chronic Inflammatory Response Syndrome and mold based illnesses for decades. All in all, we had 3 providers who treated our client give overwhelming objective evidence and reasons why they believe our client could not work. We also showed and described what our client’s typical day was which included chronic pain all over her body, migraine headaches, daily fatigue with flu like symptoms, etc.
In addition to the provider’s support, we had friends and coworkers write letters of support whereby they described what they saw from our client over the course of her issues. They were able to describe her decline and her current state which was not good. We then provided MetLife with a copy of the Mold and Bacteria Report for the building and office she was assigned to.
We drafted a very strong appeal which left MetLife with no choice but to reverse their unreasonable disability benefit denial. And thankfully they did. Our client received a sizeable check for the back benefits that were owed while MetLife reviewed this claim and she continues to receive a check every month. She continues to get treatment with the hope that she can someday return to work. But until that day, she knows that we will continue to fight for her to make sure she gets any and all MetLife disability benefits she deserves.
If you would like assistance with your Metlife disability insurance claim, our lawyers are available nationwide and we always provide an initial free phone consultation.
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