Utah Judge Reverses MetLife's Denial of Mental Disability Long Term Benefits
Factual Overview
Michelle Duncan worked for 22 years for Verizon. She started with the company upon her graduation from high school back when Verizon was known as U.S. West Paging. She worked her way up the ladder to the position of Global Enterprise Manager. It was a high-pressured job requiring travel and dealing with hundreds of email communications every day.
In 2010, she began having auditory hallucinations. She suffered from feelings of paranoia. On one out-of-town meeting, she became disoriented, not knowing where she was or why she was there. She exhibited other symptoms of a mental disorder and visual hallucinations developed along with the auditory ones.
Duncan was covered under an ERISA disability policy through Metropolitan Life Insurance Company (MetLife). The Plan provided:
1. Short term disability up to 26 weeks.
2. Long-term disability (LTD) benefits for up to 26 months if the disability remained.
3. LTD Benefits continuing to age 65 only if the mental disability is “attributable to schizophrenia, dementia, or organic brain disease.” If benefits are granted under this provision and the participant regains the ability to work in a gainful occupation for which she or he is qualified, the benefits may be terminated.
In December 2011, Mrs. Duncan was diagnosed with schizoaffective disorder and her request for short term disability benefits was granted. Her request for LTD benefits under provision three was denied. MetLife asserted that “schizoaffective disorder [is]a separate diagnosis from schizophrenia with its own diagnostic criteria.” It denied her claim for LTD benefits and she appealed. After exhausting her administrative remedies, she filed this ERISA lawsuit.
The Court disagreed with MetLife, finding that “MetLife’s literal reading is the type of overly restrictive interpretation that results in arbitrary claim denials and undermines public policy.” The Court attributed a number of errors to MetLife in its administration of the plan and its ultimate denial of benefits. The Court remanded to MetLife to reconsider the denial based on the recommendations by the court.
Met-Life Demonstrated at Least a Partial Conflict of Interest
The Department of Labor requires a claim denial to include the specific “reasons for the adverse determination.” On this record, MetLife provided Duncan a brief explanation of its denial “mere paragraphs before informing [her] that her remedies were exhausted.” This did not give her an adequate explanation of the reasons for the denial, and did not allow her to supplement the record. This left the Court with an administrative record that was not helpful. This indicated that MetLife had a conflict of interest and made its denial decision “in part to avoid a substantial payment of benefits.”
MetLife Made a Number of Errors in Its Decision that Duncan’s Diagnosis was not Schizophrenia
The Utah Federal District Court found MetLife made a number of errors in its determination that the schizoaffective disorder did not fit into the definition of schizophrenia.
· The schizophrenia exclusion is ambiguous.
· MetLife’s interpretation is unreasonable.
· Its interpretation is inconsistent with the DSM.
· Its interpretation is inconsistent with other Plan exclusions.
· Analogous case law does not support MetLife’s interpretation.
· Its interpretation undermines public policy.
With so many errors, it seems the court would award the plaintiff benefits. Instead, it remanded since MetLife had not made adequate factual findings. The court gave MetLife the opportunity “to do the factual investigation necessary to discover whether Mrs. Duncan’s specific condition could fall within the schizophrenia exclusion.”
This case was not handled by our office, but it may provide claimants guidance in their pursuit of compensation under a mental health definition of their disability policy. If you need assistance with a similar matter, please contact any of our lawyers for a free consultation.
Read more about Metlife disability claims.
Resources to Help You Win Disability Benefits
Disability Benefit Denial Options
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.
Protect Your Benefits
Get Your MetLife Disability Application Approved
We help claimants throughout the entire application process.
Prevent a MetLife Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.
Negotiate a MetLife Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
MetLife Reviews
(660)
Policy Holder Rating
5
0%
4
0%
3
0%
2
58%
1
41%
Timely Payments
2.1out of 5
Handling Claim
1.9out of 5
Customer Service
2.1out of 5
Dependable
1.9out of 5
Value
2.0out of 5
Showing 8 of 660 Reviews
MetLife
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 >
Reply
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 >
MetLife
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.
MetLife
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 >
Reply
MetLife
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.
Reply
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 >
MetLife
My husband has 2-5 yrs to live, yet MetLife has been giving him the run around
My husband has STD and LTD with his employer. He was dx with ALS/Lou Gehrig’s Disease Aug 2019, made official after many many test, as of Jan 2020 but continued to work ... read more >
Reply
MetLife
Inappropriate conduct!! Rude, discriminatory, etc
Have you ever dealt with a case where the person is receiving LTD benefits but there have been issues with the case manager? For instance, the person was badgered about an... read more >
Reply
Answered Questions by Our Lawyers
(76)
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 >
Helpful Videos
(910)
Showing 12 of 910 Videos
Disability Benefit Tips
(331)
Showing 8 of 331 Benefit Tips
How Does Having A Disability Lawyer Help Me Fight For Metlife Disability Benefits?
Metlife is one of the top five largest long term disability insurance companies. They have tons of resources and people that they rely upon to evaluate long term disability claims. Our disability insurance attorney have handled thousands of long term disability insurance claims and have the experience to give a claimant the best opportunity to collect long term ... Read More >
What Should I Expect if Metlife Wants to Send Someone to Interview me?
Metlife has a team of full time employees that go around the country interviewing long term disability claimants. These interviews are often used as the basis to deny a long term disability claim. In this video, disability insurance attorney Gregory Dell some discusses some basic things to expect if an interview has been requested. Our lawyers are available to h... Read More >
MetLife Disability Buyout and Lump Sum Settlements are Back
MetLife is one of the top five largest group and private disability insurance companies nationwide. As of January 2016 it appears that Met Life is now interested in considering the buyout of a claimant's group long term disability policy. MetLife has always done buyouts of individual disability insurance policies.For the past ten years Met Life was not interested in buying out the disability policy of a cl... Read More >
Metlife - Latest trends seen in handling ERISA and private disability insurance claims
In this video nationwide disability insurance lawyers Gregory Dell and Cesar Gavidia discuss the latest trends they are seeing in Metlife's handling of both ERISA and private disability insurance claims.... Read More >
Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?
When it comes to securing your disability insurance benefits, it's vitally important that your disability insurance lawyer thoroughly understands the symptoms and impact of your disabling condition. Doctors can help you create strong medical records, but they're not accustomed to dealing with the rigorous documentation disability insurance companies require. Lea... Read More >
Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak
If you're seeking long term disability benefits from an insurance company, you may be concerned that you're facing an uphill battle. Fortunately, the stronger your medical evidence, the greater the odds that your claim will be approved. On the other side of the coin, one of the most common reasons for denial of long term disability benefits involves too-weak med... Read More >
Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company
When you're seeking disability insurance benefits, your medical records and treating physician's statement are two of the most important components of your claim. But because the insurance company has a vested interest in denying your disability insurance claim, it often will rely on tactics like ambushing your doctor with a phone call in an attempt to get them ... Read More >
Disability Benefit Denial Reason #3 - Video & Social Media Surveillance
One thing many disability insurance claimants don't know about (or expect) from the claims review process involves video and social media surveillance. Disability insurance carriers often hire people to follow claimants around with a telephoto lens - or even send social media friend requests from fake accounts - to glean whatever information they can about the c... Read More >
Dell Disability Cases
(375)
Showing 8 of 375 Dell Disability Cases
Teacher's Disability Benefits Reinstated by MetLife
Our client, a former elementary school teacher in Broward County Florida was forced to stop working to undergo lower back surgery with a fusion. Prior to the scheduled surgery he pre-emptively filed a short-term disability claim with MetLife, which was approved prior to his surgery. Despite the surgery being a “success”, it did not alleviate his pain complet... Read More >
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 tha... Read More >
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 tha... Read More >
MetLife Approves Long Term Disability Claim For Executive Assistant with Neck Pain
Our client, a former Executive Assistant at American Express, filed a claim with MetLife under American Express's short term disability policy on account of severe cervical and thoracic pain with resulting radiculopathy that made it impossible for her to execute her job duties. Based on the medical information provided, MetLife quickly approved our client's for claim for short term disability with little resis... Read More >
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
To say my client had an intellectually demanding job is an understatement. The corporation he worked for operates in 35 countries and employs over 12,000 people worldwide. As a Senior Global Tax Director, amongst many duties, he was charged with developing and coordinating the Tax Policy of the company to ensure timely international tax compliance filings and execution of tax strategies. It was certainly an oc... Read More >
Disability Lawsuit Stories
(765)
Reviews from Our Clients
5 Ways We Help Get Your Benefits Paid
Get Your Disability Application Approved
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.
Submit A Strong Appeal Package
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.
Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of disability. We encourage you to contact any of our long-term disability attorneys for a free immediate review of your disability denial.
Sue Your Disability Company
98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability insurance attorneys have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the little guy against the multi-billion dollar insurance company giants.
We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.
Prevent A Disability Benefit Denial
Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.
Our disability insurance law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.
Negotiate a Lump-Sum Settlement
Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our disability insurance lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.
Questions About Hiring Us
Who are Dell Disability Lawyers?
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.
Do you work in my state?
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.
How can I contact you?
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.