Court of Appeals for Maryland, North Carolina, South Carolina, Virginia, and West Virginia Finds MetLife unlawfully denied LTD benefits

In this case, decided just before the holiday weekend, the claimant, “Gloria,” was employed by a wireless communications company as a customer services clerk. In that capacity, Gloria’ daily responsibilities consisted primarily of speaking with customers on the telephone and typing data into a computer. Gloria’s employer provided a group disability policy through Metropolitan Life Insurance Company (MetLife).

Gloria suffers from “trigger finger” disorder, tendinitis, and carpel tunnel syndrome. These conditions made it very difficult for Gloria to use her hands without experiencing severe pain for work activities such as typing on a computer. After Gloria could no longer work due to pain in her hands and wrists, MetLife awarded benefits for two years before cutting them off.

After her internal appeals were denied by MetLife, she brought suit under the Employee Retirement Income Security Act of 1974 (“ERISA”). The Court agreed with Gloria that MetLife’s decision was not supported by substantial evidence, noting that Gloria had had nine medical procedures to treat her conditions. Despite these numerous procedures, the described hand and wrist impairments continued to cause Gloria pain and had become a significant impediment to Gloria’s ability to type on a computer. The Court found it significant that MetLife itself had noted Gloria “is unable to turn her head and use her hands for extend[ed] periods of time due to the pain.”

The Court found that in the face of “overwhelming” evidence concerning Gloria’s continued pain and difficulty in attempting to use her hands and wrists, MetLife relied on a “scintilla of evidence” that did not directly address these problems. “MetLife appears to have disregarded, without justification, Gloria’ treating physicians’ conclusions regarding her hand and wrist pain and its effect on her ability to type throughout the day,” reasoned the Court. Plan administrators, of course, may not arbitrarily refuse to credit a claimant’s reliable evidence, including the opinions of a treating physician.

In regard to the request by Gloria’s attorneys for their contingent fees and costs, the Court considered the remedial purposes of ERISA to protect employee rights and secure effective access to federal courts. Gloria was awarded her attorneys fees and costs on the basis that there is a presumption in favor of an award of costs to the prevailing party.

This decision came from a Court that decides LTD benefit denials for claimant’s living in Maryland, North Carolina, South Carolina, Virginia, and West Virginia. The Court’s well-balanced analysis gives us optimism for other LTD claimants we represent in these states.

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Alan Olson writes this web-log to provide helpful information regarding long-term disability cases. He practices long-term disability law throughout the United States from his offices in New Berlin, Wisconsin. Attorney Olson may be contacted at [email protected] with questions about the information posted here or for advice on specific disability benefit claims.

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