MetLife Overturns its Decision to Deny Long Term Disability Benefits After Receiving an ERISA Appeal from Disability Attorneys Dell & Schaefer
Author: Attorney Alex Palamara
An Alabama woman previously employed as a Senior Account Representative since 1999 for the Southern Company’s subsidiary SouthernLINC Wireless was awarded long term disability ERISA benefits after Attorney Alex Palamara filed an ERISA appeal on her behalf. Forced to leave work on May 21, 2010 due to a countless number of conditions, the claimant was forced to file for disability benefits. The claimant’s conditions included cervical spine pain with radiculopathy, low back pain with radiculopathy, degenerative disc disease, osteoarthritis, past surgeries, etc.
MetLife Denies Benefits After 24 Months
Although initially paid for 24 months, the claimant’s benefits were denied when MetLife determined that she no longer qualified for benefits due to the change in definition of what it means to be disabled under the policy. This change in definition of disability is commonly found in group policies provided to employees.
Under these policies, when a person first makes a claim for benefits, to be considered disabled the person must satisfy that they are unable to perform each of the material duties of their own occupation. After 24 months, the definition of disability then requires that the person’s medical records prove that they are unable to perform the duties of any gainful occupation for which the person is qualified for by education, training or experience.
As you can see this new definition of disability (the any occupation definition) is much harder to satisfy than the previous definition (the own occupation definition). Insurance companies love to deny claimants continued benefits after the change in definition of disability. This was the case for the SouthernLinc employee.
Appeal Filed By Dell and Schaefer
Within days of receiving the denial letter from MetLife, the claimant contacted Disability Attorneys Dell & Schaefer for assistance in getting back on claim. Disability Attorney Alexander Palamara timely ordered and reviewed the claim file from MetLife, the Social Security Administration’s Disability Claim File, as well as the medical records from each of the claimant’s treating physicians. With the support of the claimant’s records an administrative appeal was timely filed challenging MetLife’s determination. Dell and Schaefer was able to point out the inconsistencies in MetLife’s decision and the weaknesses of its internal reviews. They were also able to point out the strong objective medical evidence that was contained in the claimant’s medical records. Faced with this strong evidence, MetLife was forced to overturn its previous decision to deny benefits.
Today, the claimant is now receiving a monthly benefit check. Should she continue to be disabled, her policy will pay her until the year 2023.
If you have a similar case or are thinking of making a claim for disability benefits with MetLife, please do not hesitate to contact our office for a free consultation and review of your claim.