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MetLife’s attempts to stop paying total disability benefits after paying claimant for 10 years is denied

Robert Clarke, a market sales manager for Allstate Insurance Company, stopped working in 1992 due to lumbar spinal stenosis, claiming he was unable to sit, stand, or walk for more than 10 minutes. Mr. Clarke was insured under his company’s group disability plan administered by Metropolitan Life Insurance Co. and was paid total disability benefits as of 1992. After several back fusion surgeries in 1990, 1992, and 1994, MetLife approved Mr. Clarke’s initial claim for benefits. In 2202, after paying total disability benefits for more than 10 years, MetLife decided to terminate Mr. Clarke’s disability benefits and claim that Mr. Clarke could perform sedentary work.

In June 2000, MetLife began disability video surveillance of Mr. Clarke. The video tapes were reviewed by MetLife’s doctors including an occupational therapist and functional capacity evaluation coordinator. In May 2002, MetLife terminated Mr. Clarke’s disability benefits stating Mr. Clarke’s restrictions and limitations are inconsistent with the video surveillance and medical records. MetLife upheld its decision on appeal and Mr. Clarke sued in the U.S. District Court for the Southern district of Ohio, for reinstatement of benefits under the Employee Retirement Income Security Act (ERISA).

After reviewing MetLife’s denial of disability benefits, Judge Michael R. Barrett stated that MetLife’s reliance on videotaped surveillance in its decision to terminate Mr. Clarke’s benefits was arbitrary. “MetLife’s assertion that plaintiff’s misrepresentation of his functional limitations somehow invalidated objective medical evidence is unreasonable” ruled Judge Barrett. MetLife was ordered to pay back-benefits to Mr. Clarke and reinstate his disability benefits.

See Robert B. Clarke v. Metropolitan Life Insurance Co., et al., No. 1:04-cv458, S.D. Ohio; 2006 U.S. Dist..



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