MetLife Denies Disability Benefits and Tells TFORCE Truck Driver Its Safe For Him to Drive
Our now client was formerly employed as a Truck Driver for TForce Logistics, which, as some may know, is one of the biggest transport and logistics companies in North America. A lifelong truck driver, our now client loved what he did and loved who he worked for. Unfortunately, various sicknesses and injuries were impacting his ability to do the job that he knew and loved. His medical conditions included Insulin Dependent Uncontrolled Type 2 Diabetes with Hypoglycemia, Diabetic Neuropathy, Sciatica, and Obstructive Sleep Apnea. Not only did his conditions leave him unable to perform each of the material duties of his own occupation as a Truck Driver, but these conditions also put many other people at risk as his conditions left him unable to safely operate his Truck on the open roads.
Thankfully, TForce offered its employees coverage under a Long Term Disability (“LTD”) insurance policy and thankfully our now client was a covered person under this LTD policy, which was fully insured by Metropolitan Life Insurance Company, more commonly known as MetLife. This policy is a very typical LTD policy whereby one has to be disabled for a period of 180 days before benefits will commence. This time period is known as the elimination period. Furthermore, the policy has a very common definition of disability which initially requires that the claimant prove for the first 24 months that he or she is “unable to perform each of the material duties of their own occupation for any employer in the national economy.” Thereafter, the policy has a “change in definition of disability” which then requires that a person be “unable to perform the duties of any gainful occupation for any employer in the national economy…” Thus, after 2 years, like most LTD policies, this policy make it a little bit more difficult to qualify.
The Initial Application for Benefits
In mid October of 2020, after a visit with his treating provider due to ongoing complaints of confusion, heart palpitations, shakiness, anxiety, blurry vision, and pain, the treating provider immediately pulled him out of work and advised him to stop driving as he was unable to continue to do so safely. Over the next few months, the treating provider even advised that he should look into another line of work as his insulin dependence and unstable blood sugars left him disabled from continuing to work as a truck driver. Knowing he could no longer safely do the job that he loved, our now client immediately stopped working and filed his claim for Long Term Disability Benefits. Armed with his medical records and the support from his treating provider, our now client gave no thought to the possibility that MetLife could deny this claim. Unfortunately, MetLife did just that.
MetLife’s Denial of LTD Benefits
Upon receiving the denial letter, with the help of family members, our now client found our firm and immediately spoke with Attorney Alexander Palamara. Upon hearing the background of the claim, the conditions he was suffering from and the type of job that he performed, it seemed unlikely to Mr. Palamara that MetLife had strong grounds to deny this claim.
A review of the denial letter indicated that MetLife believed a denial was justfied based upon the reviews of two “Independent Physician Consultants”, one of whom was board certified in Family Medicine and Occupational Medicine and the other board certified in Family Medicine and Addiction Medicine.
Essentially, MetLife went out and paid for a review of this truck driver’s medical records and these reviewers found, despite loads of evidence showing poor glycemic control, that there was “no evidence of diabetic complications causing physical impairment.” The “independent” consultants also led MetLife to conclude that there was “no evidence of neuropathy, retinopathy, impaired wound healing or frequent infections.” In the end, the independent consultants’ reports led MetLife to make a determination that our now client had no restrictions and limitations due to his disabling conditions.
Knowing that MetLife’s decision was highly questionable, Attorney Palamara immediately agreed to take on the claim and he hit the ground running.
How to Appeal a Disability Denial?
The first step in appealing any disability denial is ordering a copy of the claim file from the insurance company. Attorney Palamara did just that. Upon receipt of the claim file (which under the ERISA laws the insurance company has 30 days to provide), Attorney Palamara ripped through it to see what support was provided by the claimant with his application for benefits and to find each and every review that led MetLife to make this incorrect denial. Pulling out the reviews of the independent consultants, as well as the internal reviews of the claims handlers, Attorney Palamara was able to assess what was conveniently overlooked by MetLife and its consultants.
In addition to going through the claim file, Attorney Palamara ordered updated records from the treating providers. Medical documentation is surely needed to prove this claim and any claim as it is claimant’s requirement to file “proof” to support his or her claim. A review of our now client’s medical records showed just how dire his situation was and it showed why he was having confusion, heart palpitations, shakiness, anxiety, blurry vision, and pain.
Lastly, prior to filing the appeal, we had our client submit to physical functional testing in an effort to show that he did not have the physical ability to perform the duties of his occupation. The results of this Functional Capacity Evaluation (“FCE”) confirmed what the medical evidence was already showing: that our client’s ability to “return to his occupation would not be possible.”
The Filing of the Administrative Appeal
Utilizing arguments that showed the holes in the independent consultants’ reviews and filling those holes with (1) the medical evidence, (2) the support of the treating providers and (3) the results of the Functional Capacity Evaluation, we were able to make a compelling case that our client was certainly disabled from his own occupation and that MetLife’s decision to deny benefits was certainly wrong.
Within 36 days of our appeal being sent to MetLife, we received a faxed letter from MetLife explaining that it had “changed (its) original decision.”
In the end, MetLife finally got this claim right, but it took proof and the right arguments to ensure that this case was seen correctly by MetLife. Our now client is on claim and currently receiving benefits. And he knows that our firm will do whatever it takes to keep him on claim until he is ready and able to return to work or until his policy expires.
If you have been denied disability insurance benefits by MetLife or any disability insurance carrier, never hesitate to reach out to Attorney Palamara for a free consultation and assessment of your claim.
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