MetLife Reinstates Disability Benefits to Attorney on Appeal
Author: Attorney Stephen Jessup
Our client is an accomplished attorney working for a large international law firm who despite suffering from Bipolar Disorder was able to complete law school and excel in a highly competitive and stressful occupation. However, increasing hours and the start of a new family made it increasingly difficult for our client to perform all the duties of her occupation due to her condition. Instead of walking away from a career she had devoted many years of her life to our client cut back the number of hours she was working and filed a claim for partial disability benefits under her firm’s disability insurance policy with MetLife.
Claim Handling and Denial of Benefits
The claim for partial disability was initially approved by MetLife with very little problem. Our client continued to work a reduced schedule as suggested by her doctors and MetLife paid benefits under the policy for over three years without there appearing to be any problems with the claim. Throughout this period of time our client consistently treated with her doctors and therapist, all of whom staunchly supported her claim for benefits.
As would later be discovered, over the course of time MetLife’s review of our client’s claim appeared focus solely on the complaints of cognitive decline and problems with concentration. Instead of viewing these problems as a symptom of the whole, MetLife set to separate and disprove these symptoms in an attempt to terminate our client’s claim for benefits. To further its agenda, MetLife had our client undergo neuropsychological testing with a doctor of its choosing. The doctor hired by MetLife interpreted the testing to indicate that memory and learning functions, language processing and executive functions were normal. Based on these test interpretations MetLife terminated our client’s claim for partial disability.
Prior to contacting our Office our client attempted to provide additional information to MetLife that refuted the opinions made by MetLife’s neuropsychologist to include providing the independent opinion of a Neuropsychologist who had developed one of the tests MetLife’s doctor was misapplying and using to terminate the claim. Regardless of this extremely supportive information, MetLife advised our client that it was upholding the denial of her benefits and that she would have to formally appeal the denial of benefits.
At that time our client contacted Attorneys Dell & Schaefer and spoke with Attorney Stephen Jessup. In reviewing our client’s medical information along with MetLife’s voluminous claim file Attorney Jessup recognized that MetLife was trying to change our client’s claim for partial disability from being due to Bipolar Disorder and instead due to an unspecified Cognitive disorder. In doing so MetLife seemingly forgot or ignored that the basis of the initial approval of benefits was based on the all the documented symptoms related to the diagnosis of Bipolar Disorder, to include, but certainly not limited to issues with concentration/cognition. In preparing the appeal Attorney Jessup sought additional outside expert opinion to further refute the MetLife ordered neuropsychological testing, and also refocused the claim to take into account all the other restrictions and limitations that would preclude our client from performing all of the material and substantial duties of her occupation on a full time basis.
Following the submission of the appeal drafted by Attorney Jessup the MetLife appeals department notified our office prior to the expiration of the initial 45 day deadline to render a decision that it was reinstating our client’s claim for long term disability benefits.