Judge Agrees that MetLife's Denial of Long Term Disability Benefits was Reasonable
In Anne Ehlert v. Metropolitan Life Insurance Company (MetLife), Ehlert was a consulting pension actuary for pension plans at Towers Watson. Her first day of work with Towers was September 8, 2003. Her last day of work was December 23, 2015. In August 2016, she applied for long-term disability (LTD) benefits under her employer’s disability insurance benefit plan which was administered by MetLife.
In this case, in order to collect LTD benefits, Ehlert had to prove that due to an illness or accidental injury, she was unable to perform the duties of her own occupation. She claimed she was unable to perform these duties due to “fatigue, short term memory and cognitive organizational issues, [and] headaches.” Her claim was denied, so she appealed. When her administrative appeal was denied, she filed this ERISA lawsuit in the United States District Court for the District of Massachusetts.
The District Court analyzed four issues raised by Ehlert: 1) She was denied a full and fair review; 2) MetLife rejected evidence presented by her functional capacity evaluation (FCE); 3) MetLife rejected the report of a vocational consultant; and 4) MetLife did not give proper consideration of the award of Social Security Disability Income (SSDI) benefits awarded to her by the Social Security Administration (SSA).
The Court made a comprehensive review of Ehlert’s medical records and reports of treating physicians as well as MetLife’s reviewing physicians. Ultimately, the Court concluded that Ehlert had not sustained her burden of proving she was unable to perform the material duties of her own occupation. Therefore, MetLife did not abuse its discretion when it denied her claim for LTD benefits.
The Court stated: “MetLife made a carefully-considered decision to deny Ehlert’s application and appeal for LTD benefits. That decision was reasonable and supported by substantial evidence in the record. Under the arbitrary and capricious standard, the decision to deny LTD benefits must be upheld.”
MetLife Provided Ehlert a Full and Fair Review
The terms of MetLife’s disability benefit policy at issue in this case was whether Ehlert was entitled to LTD benefits because she was unable to perform the material duties of her own occupation. As the Court stated, “The issue is whether Ehlert submitted proof that she suffered such physical or cognitive limitations that she was disabled from working within the meaning of the LTD plan.”
There was no selective review of treating physicians. The Court noted, “There is no dispute that Ehlert has a lengthy history of reported, consistent symptoms. MetLife and its consultant physicians did not merely gloss over the treating physicians’ notes and opinions. Rather, her treating physicians’ longitudinal reports concerning these physical and cognitive limitations were recognized and acknowledged.”
Although the law is clear that a “plan administrator may not ‘cherry-pick the evidence it prefers while ignoring significant evidence to the contrary,’” the Court was clear that is not what happened here. Some of Ehlert’s numerous treating physicians opined she could not work. Others acknowledged she suffered from pain and cognitive issues but believed she could still work at her regular job. The Court meticulously analyzed all reports from Ehlert’s treating physicians.
In addition to Ehlert’s reports to her physicians of pain and cognitive limitations, she also reported that she went biking and swimming. She walked her dog, hiked, and went to the gym. One treating physician repeatedly stated that she could sit for 6-8 hours a day so could do her sedentary job. Another treating physician noted that she could work from home four hours a day.
The Court analyzed reports of MetLife’s reviewing physicians, all of whom opined that she could perform the duties of her regular occupation. The physicians had reached out to Ehlert’s physicians and, “where possible, had teleconferences to discuss Ehlert’s case. Lengthy and comprehensive consultant physician reports were submitted. Ehlert’s LTD benefits decision was thirteen pages in length and detailed.”
The Court made it clear that just because the “physician consultants disagreed with plaintiff’s treating physicians does not mean that they ‘deemphasized’ their clinical evaluations and findings.”
MetLife did not reject the FCE. A physical therapist performed an FCE, a four-hour test in this case. The therapist opined that Ehlert could not work at a sedentary or light physical capacity on a full-time basis and concluded that Ehlert’s fatigue and other symptoms were “due to Lyme Disease.”
MetLife’s reviewing consultant disagreed with the opinion, stating the physical therapist “was not a physician and [was] not qualified to offer such an opinion.” There were other tests administered to Ehlert that contradicted the conclusions presented by the physical therapist in the FCE. Plus, the Court found that during this same time period, Ehlert reported she was riding her bike seven miles three or four times a week and frequently swimming, even at the same time she was saying she could not work because of fatigue.
The Court concluded, “In sum, the FCE is not the only evidence bearing on Ehlert’s functional limitations.” The Court held it was not its place to determine the weight MetLife should have given to the FCE.
MetLife did not reject the report of the vocational consultant. A vocational consultant reviewed the medical records as well as Ehlert’s education and vocational history. The consultant concluded that Ehlert could not manage “even Sedentary, part time work.” The consultant criticized the reports of MetLife’s consulting physicians since none of them had personally examined Ehlert.
The opinion of the consultant is contrary to the law of this circuit where courts “have treated a nonexamining physician’s review of a claimant’s file as reliable medical evidence on several occasions.”
Consideration of SSDI benefits. The decision of the SSA to award SSDI benefits is not binding on disability insurance companies. The criteria relied on by the SSA is different than what MetLife relies on. According to the Court, “it was up to MetLife to determine the weight to be afforded the decision awarding SSDI benefits.”
This case was not handled by our office, but we believe it can be helpful to claimants who are struggling to meet their burden of proof so they will qualify for LTD benefits. If you have questions about this case, or any aspect of your disability claim, contact one of our disability attorneys at Dell & Schaefer for a free consultation.
Resources to Help You Win Disability Benefits
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
Q: Would any new disabling conditions be considered by Metlife when considering whether or not to continue my benefits?
Q: Do I have to sign and return MetLife's authorization to disclose my info in order to continue my claim?
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
Very satisfied with the work of this team. Took well care of my case and took all the necessary time to be responsive and attentive when I had questions. Guided me through recovery and returning to normalcy. All thanks to Jason & Tabitha, thank you!
I’m extremely satisfied with the experience I have had with this firm from day one. The lawyer who has handled my case, Alex, is very efficient and attentive to all my questions and concerns. They are always aware of how my case has gone and they care about my health. I feel optimistic with them because they are very attentive during the process of my claim. I would not hesitate to recommend families and friends if in any situation they need their services. Kathleen as well has been very well and assisted me with this case. I highly appreciate everything they have done for me.
It’s unfortunate when disability insurance companies come after older disabled policyholders just to help their bottom line. It can be a living nightmare the damage they can do to a family. Dell Disability Lawyers are polite, understanding and knowledgeable. They call you back and answer any question you have no matter how unimportant it can be. The amount of stress they took off of myself and family was incalculable. I recommend them highly to take care of any disability case whether it be filing for benefits or reversing a claim decision. They are outstanding.
I could not have been happier or more appreciative of the hard work they performed on my behalf. I was well briefed on my case and it was closed in a timely manner with a financially successful resolution.
Mr. Symonds and Sonia as well as everyone else we have worked with throughout this process have been very helpful, professional and caring to our situation. We are very thankful to have this great team on our side.
Without them my LTD company was dropping my plan with me still suffering from my accident, even with doctor’s statements I’m still disabled. The LTD company didn’t want to advance my policy to the next stage of years of pay. Dell Disability Lawyers saved my policy, and helped to enforce the LTD company’s own policy (for its policy holder, me) that I would be covered still under the LTD policy I had paid for at my previous job, when my accident occurred. These lawyers know what they are doing and can help you too. LTD companies will try to drop you when you still need coverage just because they don’t want to pay on your policy anymore. Don’t let them break contract with ya because they are trying to get out of it. Hit em with legal action to ensure the continuation of your policy you paid for. Dell Disability worked very well for me and continue to do so.
I was denied long term disability benefits from The Hartford after being on it for years. I found Dell Disability Lawyers after doing research online. In a matter of days they responded and explained to me everything that would be done. Dell Disability Lawyers were able to settle my suit against The Hartford very quickly and responded to me quickly. I would definitely recommend this team of lawyers for anyone that is fighting for their disability insurance.
I have had nothing but a great experience with Dell Disability Law Firm. Mr. Alex Palamara and his team went above and beyond my expectations. They will respond to emails and phone calls in a timely manner. Thank you once again for taking my case.
This law firm is the best so far. MetLife denied me two times, they appealed two times for me and they won of course. So if you are on disability and want a chance at winning your case use this firm Dell disability lawyers, kind courteous understanding and they get the job done. You won’t be disappointed.