Are the opinions of your treating physician's entitled to more deference?
The short answer, as you may have already learned, is no. Under ERISA, the opinions of treating physicians, despite the physicians often having the closest contact with the patient/claimant under review, despite arguably having the most “accurate” medical information on the claimant and despite being perhaps the only physicians who have had the chance to actually meet the claimant in person and so arguably the physicians in the best position to say whether their patient is unable to work are not entitled to special deference. In fact, ERISA allows a disability insurer or the claims administrator reviewing an ERISA claim to rely instead on the opinions of internal physicians working for them who often only conduct medical “file reviews” and may never actually meet the claimant in person.
However, in a recent opinion out of the Western District of Michigan the Court explained that although a treating physician’s opinion is not dispositive by any means, a disability insurer must substantively consider such an opinion and factually distinguish it if denying the claim. In other words, the insurer may ignore the treating physician’s opinion but has to explain why and give a good reason for doing so.
In Vochaska v. Metlife, Dr. Liscow made clear his opinion that his patient, Vochaska, could not work full-time due to post-concussion symptoms, such as sensitivity to light and sound, nausea, and headaches.
Although the conditions on which Dr. Liscow’s opinion was based consistently appeared in the records submitted by Dr. Liscow, and were cited by Vochaska in his application for disability, MetLife, in denying Vochastka’s claim, ignored them and did not discuss the conditions except to state that it had “not received medical to support [Vochaska’s] complaints of a physical impairment due to headaches [and] light and sound sensitivity.”
MetLife assigned the file review to a psychologist whose medical expertise would not permit her to comment on “non-psych medical regarding any possible impairments due to light and sound sensitivity or headaches.”
On appeal, although MetLife had two additional internal physicians perform file reviews, neither report offered any insight into the conditions upon which Dr. Liscow based his opinion that Vochaska was disabled. Neither physician even attempted to explain why he or she reached a different conclusion from Dr. Liscow.
As the court explained, “MetLife was not required to accept Dr. Liscow’s opinion, but it could not reject it without reason.” MetLife’s failure to provide reasons for adopting an alternative opinion helped the court conclude that MetLife had abused its discretion.
Although the court did not ultimately find that the record clearly established Vochaska was disabled and instead remanded the case for further evaluation, the opinion is nevertheless a “win” for ERISA disability claimants.
This case is a reminder that disability insurers review claims with the ultimate goal of denying the claim in hopes that the claimant will not fight back. So it is not surprising when an insurer disregards the opinion of a physician supporting a finding of disability. But if a disability insurer chooses to ignore a treating physician’s opinion it must provide reasons for doing so and factually distinguish that doctor’s opinion from its reviewing physicians.
It is important to also remember that the mere opinion of your treating physician that you are disabled will not be enough to combat a disability insurer’s ultimate goal of denying the claim.
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MetLife Reviews
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They will do anything to not approve your claim
MetLife’s handling of my short-term disability claim has been incredibly frustrating and stressful. I followed all the necessary steps prior to my surgery, providing the... read more >
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MetLife
They FULL OF ****
MetLife is what everyone on this review are saying. They don't contact you to let you know what's going on with your claim or to let know you need additional info. I had a... read more >
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MetLife for disability? Avoid the surgery unless it's life-threatening
The worst company I ever dealt with, never received a call from my claim manager.
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Only care about $$$$$
PLAY THEIR GAME FIGHT FIRE WITH FIRE.....after getting a copy of the insurance policy from my HR. I nipped a lot of the headaches quickly by calling their bluff word for w... read more >
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They demanded an overpayment, stopped my claim, and lied about it
Metlife over paid me. Stopped my Ltd claim. The overpayment were not done right. They lied and said they deposited money in my account.
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MetLife
Your decision making process is absurd!
My wife went through a nightmare with a back surgery for two discs. When the first surgery took place, the Dr. cracked a different vertebrae as they placed the metal rods ... read more >
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My husband has 2-5 yrs to live, yet MetLife has been giving him the run around
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Inappropriate conduct!! Rude, discriminatory, etc
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Answered Questions by Our Lawyers
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Showing 8 of 76 Answered Questions
Q: Can Metlife reduce my LTD benefit due to SERP payments that were not paid to me (they went directly to FICA taxes)?
A: Jim:If this payment is a form of a retirement or pension payment then it is likely correct for Metlife to of... Read More >
Q: Do I have an option after my appeal is denied?
A: Lauren:If your appeal is denied by MetLife then you have the option to file lawsuit in federal court. Read More >
Q: My daughter died in 2019
A: If your daughter was disabled prior to being terminated then she should have coverage. Read More >
Q: Can I sue Metlife for non payment of approved claim?
A: Unfortunately, the answer is "not liklely." I would assume your MetLife policy is an employer provided policy ... Read More >
Q: How far behind in payments does Metlife have to be to take legal action?
A: Make sure you put all of your requests in writing so there is a record should you end up in court. It’s best... Read More >
Q: Does Metlife pay Disability payments ahead? Example: December payment is for January.
A: Peg, most disability insurers pay monthly disability benefits in arrears, in other words, payments are made fo... Read More >
Q: Would any new disabling conditions be considered by Metlife when considering whether or not to continue my benefits?
A: The change in diagnosis will likely lead to denial so please explain the situation to your treating doctor. Me... Read More >
Q: MetLife: Mental Health and Physical Disabilities
A: If you have physical disabilities that prevent you from working then you have options to get around the mental... Read More >
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MetLife Approves Disability Benefits to Dentist With De Quervain's
Prior to contacting our office, our client filed a claim for long term disability benefits under his individual disability insurance policy with MetLife on account of de Quervain’s Tenosynovitis, a condition affecting the tendons of the thumb and wrist that resulted in severe pain in his dominant hand, especially with grasping. Given the nature of his occupation as a Dentist, and the fact his condition was a... Read More >
Dell Disability Lawyers Successfully Appeals Metlife Denial of Benefits to Veteran
Mr. A contacted our firm after being denied benefits by his employer’s group disability carrier, MetLife. He had been working as a supervisor for a large manufacturer of heavy duty automotive components. His job required him to perform prolonged physical activities like climbing, kneeling, standing, pulling grasping, lifting and working with various tools.He was suffering from a long list of medical cond... Read More >
Metlife Overturns Denial on Appeal by Dell Disability Lawyers
Mr. W was working as a Quality Assurance Engineer for a major technology company when he was forced to stop working at the age of 52. He had been suffering from severe heart disease and co-morbid complications. He also suffered a heart attack and had a progressively worsening diabetic foot ulcer which required him to use a knee scooter to ambulate.After filing a claim for disability benefits under his empl... Read More >
Senior Global Tax Director for billion dollar worldwide industrial company is again receiving disability benefits from MetLife after Appeal by Attorney Alexander Palamara
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Our goal is to get your application for disability insurance benefits approved. Applying for disability insurance benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their hired gun doctor.
Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.
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If your disability insurance benefits have been wrongfully denied, then our disability insurance lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.
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We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.
Our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement in more than 98% of our cases. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.
We offer disability insurance attorney representation nationwide and we welcome you to contact any of our LTD lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 900 videos and regularly provide tips to help protect your disability benefits.
Who do you help?
Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.
Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.
A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.
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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 insurance 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 phone, email, fax, or video conferencing sessions. 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 insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers 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.