Our client had been a highly successful financial planner who had spent his adult life working in a field he not only excelled in, but loved. For some time he had been suffering from Restless Leg Syndrome (“RLS”), which resulted in Insomnia, which in turn resulted in anxiety, depression and cognitive difficulties. Despite numerous attempts to adjust his work schedule, he found it harder and harder to be able to focus at work. He constantly found himself being awoken at night due to his RLS, and from there the pattern of sleepless nights began. As the lost hours of sleep began to compile he faced the realization that his ability to provide his clients with the top notch financial advice and investing they deserved and he demanded of himself was being compromised. Faced with this difficult reality he filed a claim for short term disability benefits with MetLife under his employer’s group disability policy.
The Application For Short Term Disability Benefits with MetLife
At first things ran relatively smooth for our client. He submitted his application on his own, and his disability claim was initially approved. For approximately five months benefits were paid without any hitches or indications of trouble on the horizon. However, with one month left on short term disability and a pending long term disability claim, MetLife terminated his claim for benefits, essentially disregarding the overwhelming amount of medical evidence that it had once used to approve his claim.
The MetLife ERISA Appeal
After the denial of his claim, our client contacted Attorneys Dell & Schaefer and met with Attorneys Gregory Dell and Stephen Jessup to discuss his claim in detail. Attorneys Dell and Jessup were surprised that MetLife had denied the claim in the face of numerous objective medical tests and records from a half dozen physicians they had on file. We quickly obtained a copy of the claim file and our client’s medical records. Review of the claim file indicated that MetLife only had the file reviewed by a general practitioner who was not qualified to comment on our client’s medical records from a neurological or neuropsychological perspective. Our evaluation of the claim revealed that the final disability denial was based on a single note in a medical record that indicated our client was “sleeping better.” These two words were enough for MetLife to terminate the benefit and cause our client financial hardship.
With the information before him, Attorneys Jessup and Dell set to work to undermine every erroneous comment and assertion made by MetLife. We coordinated with our client’s treating physicians to respond to the report created by MetLife’s doctor; to provide additional statements in support of disability; consulted with an independent sleep expert and even a physiatrist to conduct a functional capacity evaluation to document how the lack of sleep our client experienced resulted in levels of fatigue that would prevent him from physically working full time. When all was said and done, Attorneys Jessup and Dell submitted a 54 page written appeal letter along with 364 pages of documentation to support our client’s claim for continued benefits.
MetLife Reverses Their Decision to Deny Disability Benefits
Faced with the overwhelming amount of information and arguments we presented, MetLife overturned the denial of our client’s claim for short term disability benefits. However, it should be noted that the story does not end there. As mentioned, MetLife denied the claim for STD benefits with one month of benefits left, so in overturning its decision to deny benefits, MetLife approved the remaining month only. MetLife is now reviewing the claim to determine eligibility for long term disability benefits. However, based upon the strength of the appeal it is expected that MetLife will also approve the claim for LTD benefits. We will continue to represent our claim on an ongoing basis to make sure the disability claim is paid on a monthly basis.
Has your carrier denied your claim with only a few months left on short term disability or prior to a change in definition in your policy?
Insurance companies will often terminate or deny a disability benefit just prior to a claim for long term disability benefits (as is the case above), or just before the change in definition from “own occupation” to “any occupation.” This, in turn, builds in the ability for the insurance company to overturn a decision for the limited amount of time left under short term disability or under the own occupation definition of disability and then deny the claim again based upon the new policy language. It serves as another strong-arm delay tactic and is just another example of the techniques and tactics employed by the insurance companies.
If you’re experiencing difficulty with your insurance carrier or your claim has been denied prior to the start of long term disability benefits or just before your definition of disability is about to change from “own” to “any” occupation then please feel free to contact Attorneys Dell & Schaefer for a free consultation to discuss how we may be able to assist you.