Utah Judge Reverses MetLife’s Denial of Mental Disability Long Term Benefits

Factual Overview

Michelle Duncan worked for 22 years for Verizon. She started with the company upon her graduation from high school back when Verizon was known as U.S. West Paging. She worked her way up the ladder to the position of Global Enterprise Manager. It was a high-pressured job requiring travel and dealing with hundreds of email communications every day.

In 2010, she began having auditory hallucinations. She suffered from feelings of paranoia. On one out-of-town meeting, she became disoriented, not knowing where she was or why she was there. She exhibited other symptoms of a mental disorder and visual hallucinations developed along with the auditory ones.

Duncan was covered under an ERISA disability policy through Metropolitan Life Insurance Company (MetLife). The Plan provided:
1. Short term disability up to 26 weeks.
2. Long-term disability (LTD) benefits for up to 26 months if the disability remained.
3. LTD Benefits continuing to age 65 only if the mental disability is “attributable to schizophrenia, dementia, or organic brain disease.” If benefits are granted under this provision and the participant regains the ability to work in a gainful occupation for which she or he is qualified, the benefits may be terminated.

In December 2011, Mrs. Duncan was diagnosed with schizoaffective disorder and her request for short term disability benefits was granted. Her request for LTD benefits under provision three was denied. MetLife asserted that “schizoaffective disorder [is]a separate diagnosis from schizophrenia with its own diagnostic criteria.” It denied her claim for LTD benefits and she appealed. After exhausting her administrative remedies, she filed this ERISA lawsuit.

The Court disagreed with MetLife, finding that “MetLife’s literal reading is the type of overly restrictive interpretation that results in arbitrary claim denials and undermines public policy.” The Court attributed a number of errors to MetLife in its administration of the plan and its ultimate denial of benefits. The Court remanded to MetLife to reconsider the denial based on the recommendations by the court.

Met-Life Demonstrated at Least a Partial Conflict of Interest

The Department of Labor requires a claim denial to include the specific “reasons for the adverse determination.” On this record, MetLife provided Duncan a brief explanation of its denial “mere paragraphs before informing [her] that her remedies were exhausted.” This did not give her an adequate explanation of the reasons for the denial, and did not allow her to supplement the record. This left the Court with an administrative record that was not helpful. This indicated that MetLife had a conflict of interest and made its denial decision “in part to avoid a substantial payment of benefits.”

MetLife Made a Number of Errors in Its Decision that Duncan’s Diagnosis was not Schizophrenia

The Utah Federal District Court found MetLife made a number of errors in its determination that the schizoaffective disorder did not fit into the definition of schizophrenia.

· The schizophrenia exclusion is ambiguous.

· MetLife’s interpretation is unreasonable.

· Its interpretation is inconsistent with the DSM.

· Its interpretation is inconsistent with other Plan exclusions.

· Analogous case law does not support MetLife’s interpretation.

· Its interpretation undermines public policy.

With so many errors, it seems the court would award the plaintiff benefits. Instead, it remanded since MetLife had not made adequate factual findings. The court gave MetLife the opportunity “to do the factual investigation necessary to discover whether Mrs. Duncan’s specific condition could fall within the schizophrenia exclusion.”

This case was not handled by our office, but it may provide claimants guidance in their pursuit of compensation under a mental health definition of their disability policy. If you need assistance with a similar matter, please contact any of our lawyers for a free consultation.

Read more about Metlife disability claims.

Leave a comment or ask us a question

Questions About Hiring Us

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.

Dell & Schaefer Client Reviews   *****

Gary Z. (Ohio)

Steve and Danielle were so wonderful to me and my wife. We were so upset with our situation with Cigna and I called Dell & Schaefer and was transferred to Attorney Stephen Jessup. I can’t explain how he eased my mind. He was so professional and educated on the subject of disability insurance and made me comfortable that he would help me. Any time I had a question I could call or email them and they got right back to me. The friendliness and helpfulness was amazing. Steve Jessup helped me win my case and I can’t thank him and his company enough.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us