Fibromyalgia Claimant Wins MetLife Disability Insurance Lawsuit
MetLife determined a disability claimant with Fibromyalgia was not disabled after two years of receiving benefits, but a California Federal Judge disagreed. Federal courts in California have stood behind employees and forced insurance companies to pay disability benefits. We want to be your California disability attorney and make the disability insurance company pay your benefits. The law governing disability insurance claims is complex and often skewed in favor of the insurance company. Let’s take a look at a court decision in which a California Federal Judge reversed a MetLife disability denial.
MetLife is Ordered to Pay Disability Insurance Benefit
In Lavino v. Metropolitan Life Insurance Company, a federal court in California found that the insurer had abused its discretion in denying long-term disability benefits under an ERISA plan. The plaintiff had been a civil project engineer for ten years. However, she sought medical leave and disability benefits in 2005 due to chronic pain and fatigue linked to fibromyalgia. After paying benefits for nearly two years, the definition of disability changed from own occupation to any occupation. The claimant was forced to return to work – even though her condition had not improved and her doctor still considered her unable to perform any work.
MetLife Denial of Long Term Disability Benefits Includes Numerous Mistakes
When the plaintiff sued to recover the disability benefits, she pointed to procedural and substantive mistakes in the way MetLife processed the claim, including:
- MetLife misclassified the plaintiff’s job position as light duty when, by MetLife’s own prior analysis, the position was medium duty;
- MetLife failed to provide its paper medical reviewer – upon whose opinion was the sole basis for the denial of benefits – with important details about the claim;
- MetLife imposed a requirement of objective evidence to show a disability when the plan had no such requirement; and
- MetLife reversed its position after two years of accepting the plaintiff’s medical record as indicative of her inability to work.
The California federal court found that MetLife had abused its discretion in denying the benefits. The court recognized that, although the plan gave MetLife discretion, that discretion has limits. Sometimes a searching inquiry is required and this was one of those instances. MetLife decided who got benefits and Metlife was also responsible for paying those benefits. This necessarily created what the court described as a structural conflict of interest. With a financial incentive to deny coverage, the court refused to overlook the unreasonable and arbitrary manner in which MetLife denied benefits. These actions cast doubt on MetLife’s ultimate conclusion. The court’s skepticism led it to find that MetLife’s denial of long-term disability benefits could not be sustained and ordered MetLife to reinstate benefits.
Lavino v. Metropolitan Life Ins. Co., 779 F. Supp.2d 1095 (C.D. Cal. 2011).
Resources to Help You Win Disability Benefits
Submit a Strong MetLife Appeal Package
We work with you, your doctors, and other experts to submit a very strong Metlife appeal.
Sue MetLife
We have filed thousands of disability denial lawsuits in federal Courts nationwide against Metlife.
Get Your MetLife Disability Application Approved
Prevent a MetLife Disability Benefit Denial
Negotiate a MetLife Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Policy Holder Rating
They demanded an overpayment, stopped my claim, and lied about it
Reply
Your decision making process is absurd!
My husband has 2-5 yrs to live, yet MetLife has been giving him the run around
Reply
Inappropriate conduct!! Rude, discriminatory, etc
Reply
Haven't been paid since MetLife denied my appeal months ago
Reply
Metlife closed my STD claim amid several injuries
Reply
Metlife's COLA recalculation cut my payments with no explanation why
Reply
MetLife stopping my benefit plan. I'm still disabled
Reply
Q: Is MetLife entitled to overpayment if they realized 15 years later?
Q: Do I have to sign and return MetLife's authorization to disclose my info in order to continue my claim?
Q: How long does MetLife have to render a decision on my application for benefits?
Q: I found out about my STD policy 120 days late. Can I do anything?
Q: Does my former employer owe me STD that he refused to pay earlier?
Q: Can MetLife cut my monthly benefits by my benefits received from social security?
Q: Will Met Life set me up on a payment plan if I have already spent my back pay from SSDI? Can they arrest me?
Q: Can MetLife remove my LTD claim from their web site?
How Does Having A Disability Lawyer Help Me Fight For Metlife Disability Benefits?
What Should I expect if Metlife wants to send someone to Interview me?
MetLife Disability Buyout and Lump Sum Settlements are Back
Metlife - Latest trends seen in handling ERISA and private disability insurance claims
How to Apply for Reliance Standard Disability Benefits & Top 5 Reasons for a Claim Denial
Applying for Standard Disability Benefits? Top 5 Claim Denial Reasons
Guardian Disability Benefit Claim Handling Tips
Application Tips: Northwestern Mutual Disability Benefits - Top Denial Reasons
Teacher's Disability Benefits Reinstated by MetLife
MetLife Denies Disability Benefits and Tells TFORCE Truck Driver Its Safe For Him to Drive
Contracts Manager With Toxic Encephalopathy Wins MetLife Long Term Disability Denial Appeal
MetLife Approves Long Term Disability Claim For Executive Assistant with Neck Pain
MetLife Approves Disability Benefits to Dentist With De Quervain's
Dell Disability Lawyers Successfully Appeals Metlife Denial of Benefits to Veteran
Metlife Overturns Denial on Appeal by Dell Disability Lawyers
Senior Global Tax Director for billion dollar worldwide industrial company is again receiving disability benefits from MetLife after Appeal by Attorney Alexander Palamara
Reviews from Our Clients






