Metlife’s wrongful denial of long-term disability benefits to a Wells Fargo employee is reversed

Many employees rely on disability insurance benefits if they have been injured or have developed a sickness which prevents them from working.  Disability insurance provides individuals with a percentage of his or her typical salary until the employee is able to return to work or turns age 65. However, what employees aren’t usually aware of is that as soon as disability benefits start, the disability insurance company wants them to stop – and they will use a wide range of tactics to make that happen.

As an attorney who has worked on thousands of long-term disability claims against major insurance companies around the country, I can tell you that insurance company tactics can involve undercover investigations, fact-twisting, and even having bias doctors subjectively determine that you are not disabled  as in a recent disability insurance case.

Graciella Saffon vs. Wells Fargo

Graciella Saffon, an employee of Wells Fargo Bank, had suffered from degeneration of her cervical spine for several years. This condition was confirmed by several MRIs, X-rays and other medical information. In 2001, Saffon was in a car accident which aggravated her neck condition, leading her to quit her desk job and apply for long-term disability benefits with MetLife. After a certain amount of time, the insurance company began paying Saffon long-term disability.  However, a year after she began receiving these long-term benefits, MetLife stopped paying them, informing her that she no longer met the terms of disability.

How MetLife Worked to Deny Mrs. Saffon Her Long-Term Disability Benefits

MetLife hired two different doctors to look over Saffon’s medical records, resulting in the following statements.

The first physician, Dr. Thomas, stated that “Saffon’s file lacks clear sequential, detailed and objective clinical information, which would completely preclude Ms. Saffon from an attempt to return to work.”

After Dr. Thomas’s file review, MetLife stopped the long-term benefit payments. Saffon appealed MetLife’s denial and provided an updated cervical MRI with additional medical records.  A letter from her neurologist, Dr. Kudrow, was also included, stating that she had undergone various pain treatments which were ‘without sustainable benefit’ and that she was unable to remain in a sitting position for more than a few minutes at a time.

Following the submission of the Appeal, a second doctor, Dr. Menotti, looked over Saffon’s records and claimed that her reports of headaches and chronic pain syndrome were not enough to keep her from working. MetLife then stated that Saffon had not supplied them with a functional capability evaluation so they were unaware of her ability to function at work. The appeal was denied.

Mrs. Saffon sued MetLife in California District Court, seeking back-payment of her disability income benefits. The District Court affirmed MetLife’s denial, and Mrs. Saffon continued her battle for disability benefits by filing an appeal with the 9th Circuit Court of Appeals. After reviewing the case, Judge Kozinski determined that MetLife had not given Saffon’s case a full and fair review for the following reasons:

Judge Kozinski remanded the case back to the California District court, requiring that they give a full and fair look at Mrs. Saffon’s case taking into account the flaws in their review process and the ERISA laws. This was a victory for Ms. Saffon, who was given a second chance to show that she most certainly did deserve disability benefits due to her inability to work. However, one has to note that Mrs. Saffon did everything she could to show this in the first place, and had MetLife acted reasonably, Mrs. Saffon would not have had to go without her disability benefits or go through a painful and drawn out battle in court at all.

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There are 8 comments

  • Maurice,

    Unfortunately you cannot sue for damages under an ERISA based disability insurance policy. How long has your case been in federal litigation? Based on deadlines imposed by the court there may be little that can be done to assist you. Please feel free to contact our office to discuss in greater detail.

    Stephen JessupJul 18, 2015  #8

  • I was denied disability benefits by metlife. My employer told me to file the claim and it was denied by metlife. The lady responsible for investigating and recording it left out information that would have been favorable to my appeal and she never responded to any of the doctors that were treating me. I was denied of course at the appeals process and I then filed a small claims matter which was later moved to the federal courts due to my citing of denial of due process at the appeals level. I would like to know whom I can speak with in my area to sue for these benefits and damages.
    Thank you

    MauriceJul 17, 2015  #7

  • Carol,

    Typically, pre-existing condition clauses found in disability policies are not found in worker’s compensation claims. I would strongly recommend you contact a Worker’s Compensation attorney to discuss your options.

    Stephen JessupDec 31, 2014  #6

  • Does this pertain to disability due to work accident? I was denied from the insurance saying it was a preexisting condition even though it was reported through work because they changed insurance!

    Carol MichelsonDec 30, 2014  #5

  • Kim,

    Your case will be heavily dependent on the pre-existing language contained in your company’s policy. I would suggest getting a copy of the policy if you don’t already have one. Please feel free to contact our office to discuss how we may be able to assist you.

    Stephen JessupJan 18, 2014  #4

  • My name is Kim, I am a recruiter at Wells Fargo for 10 months. I started making many mistakes at work and became very concerned. I went to my physician for a check up in July 2013 and let her know of the mistakes I was making and also let her know that while driving I got lost. She sent me to a Psychologist for testing and she said I had a small stroke and wanted me to not work until January 15th 2014 when she would re-test me. She referred me to a neurologist who sent me to a Psychiatrist who determined I was very depressed and he changed my medication and did a round of ECT treatments. He said I should apply for Social Security benefits. I do see a therapist twice a week as well. I find it very difficult to leave my home. I don’t sleep much and I am severely depressed with anxiety.

    Wells Fargo did pay me short term disability from July until 1/6/14. I did pay for long term disability through payroll deductions as a benefit. I was denied long term disability because they said this was a pre-existing condition. My mom died in 2004 and I started taking Cymbalta. Please help me if you can, I am very afraid and destitute.

    KimJan 17, 2014  #3

  • Larry,

    Please feel free to contact our office for a free consultation to determine how we may be able to assist you in filing an appeal of the denial of benefits.

    Stephen JessupAug 11, 2013  #2

  • I was just denied long term disability by MetLife due to a preexisting condition that has nothing to do with the reason I was off from shoulder surgery. I have been off work for 15 months from having 2 shoulder surgeries. They said that they made this determination due to my pharmacy records and prior medical conditions. They are refusing to pay me the $4400.00 per month they said they would pay me up to the age of 65. I’m 54 at this time.

    Larry BrixeyAug 10, 2013  #1

FAQ

Do you help MetLife claimants nationwide?

We represent MetLife clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a MetLife disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from MetLife. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by MetLife.

How do you help MetLife claimants?

Our lawyers help individuals that have either purchased a MetLife long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with MetLife:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Reviews   *****

Daniel L. (Tennessee)

Working with Jay Symonds restored our lives. The day we received the letter from our long term disability insurance Co. stating they were not going to cover my spouse was paralyzing. After much research searching for a legal firm to handle our case we decided on Dell and Schaefer. Mr. Symonds called me the day I contacted the firm. He explained the process in detail, timelines and what would be expected of us. Mr. Symonds works long hours as well as his staff.

My spouse suffered a life altering stroke of which he will need caregiving the rest of his life. This fact is stressful in and of itself. To add an extra burden the insurance company wanted to drop my spouse. Mr. Symonds made sure my spouses policy was reinstated. My statement is grossly understated on all levels. There is little space to go into the depth of detail. If you are on the site reading this testament then you are all too familiar with the what happens to your life when you or your spouses health suffers.

Lastly, I/we owe our deepest gratitude to Mr. Symonds and his team for helping us through this difficult time. It is emotional writing this but I want people to know there is help.

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