A former Event Coordinator for CITGO covered under a group insurance policy by MetLife was denied long-term disability coverage based on the any occupation definition of long-term disability.
The Event Coordinator filed a claim for long-term disability with MetLife based on hypertension, memory loss, diabetes neuropathy, and post-traumatic stress disorder. MetLife approved his claim under the own occupation definition of total disability for the 12-month period of own occupation disability in the policy. After 12 months, the definition of total disability changed to any occupation, and the nurse reviewing the case determined that the claimant had the ability to work in any occupation other than as an Event Coordinator, and therefore no longer met the applicable definition of total disability under the policy.
On appeal, two independent physicians found there was nothing in the medical records to indicate the former employee could not work in another occupation. The trial court granted summary judgment to MetLife; on appeal, this decision was upheld.