I’m totally thrilled after getting news tonight from the Northern District Court of California that our client, “John,” won his LTD benefits case against MetLife.
A. John’s Employment
John’s job duties included evaluating and understanding a variety of patents and technologies in mining and intellectual property. His position required “an advanced/graduate degree in a science or engineering discipline, particularly in the information and communication technology areas. John’s job was sedentary-to-light; it required sitting at a workstation doing computer work and reading.
John fell backward onto his buttocks and back. Thereafter, he complained of back pain, intermittent leg numbness and pain, pain and/or numbness in other areas, headaches, blurred vision, and dizziness. John continued to work for several months, but only for partial days and weeks. He then stopped working completely, asserting that his back pain had become intolerable and filed a claim for LTD benefits under the Plan. He claimed that he was unable to sit, walk, or stand for more than three to five hours in the workday.
B. MetLife Used Wrong Claim File to Deny John’s Benefits.
MetLife sent John a denial letter stating that he had failed to prove entitlement to benefits under “the United Airlines plan.” According to the letter, MetLife attempted to call John but his telephone number was “disconnected”. John wrote back asking whether the letter had been sent to him in error, since he did not work for United Airlines and his telephone had not been disconnected. John included his telephone number in the letter, stating that it had been prepaid though the year.
MetLife sent John a second denial letter again asserting that John’s telephone number had been disconnected, and that it had been unable to reach John’s “doctor.” The letter stated that “[s]ince we have not received the requested information, you’re [sic] Long-Term Disability benefits have been denied.” MetLife then sent John a third denial letter, this time, misstating John’s occupation.
C. MetLife Improperly Ignored Social Security Decision
The Court held that the Social Security decisions would be persuasive evidence that John was disabled as required by the Plan, because, the Social Security standards are more stringent in this instance. “Moreover, the Supreme Court has found questionable MetLife’s conduct in requiring a claimant to argue to the Social Security Administration that she could do no work, and then ignoring the agency’s finding in concluding that the claimant in fact could do sedentary work”, said the Court.
D. Proof Of Disability
The Court found it “undisputed” that John fell in the manner claimed, and that he suffered disc desiccation, broad-based disc bulge, and disc protrusion at L4-5. Five different physicians that either treated or examined John opined that he had significant limitations on sitting and standing and “[c]hronic disabling lumbar pain of probably diskogenic etiology”. The Court said that it was, “at a loss to imagine how [John] could perform his own occupation, which undisputedly consisted primarily of sitting in front of a computer, if he could not sit.” It was also found significant that none of the physicians expressed doubts as to the degree of pain reported by John; there was no suggestion that he was malingering.
E. MetLife Relied On Mere Paper Review
The only doctors who suggested that John did not suffer disabling pain were the two doctors hired by MetLife, Drs. Smith and Turok. Neither Dr. Smith nor Dr. Turok ever met or examined John; thus neither had any opportunity to assess his credibility. The Court concluded that under these circumstances, it was an abuse of discretion for
MetLife to reject John’s subjective pain complaints and, based upon that rejection, to discount the medical opinions that credited those complaints. While a plan administrator is not required to subject the claimant to an in-person medical examination, in performing the abuse of discretion analysis the Court may consider the fact that the administrator relied upon a paper examination.
MetLife’s hired doctors focused on John’s “refusal” of a lumbar epidural steroid injection and/or surgery. However, as noted by the Court, MetLife did not point to any evidence that agreeing to a steroid injection and/or surgery were the only reasonable medical decisions that John could make.
F. MetLife Abused Its Discretion
In considering the administrative record as a whole, including the consistency of John’s pain complaints from the time of his fall onward, the MRI demonstrating a disc injury, the opinions of five different doctors who treated or examined John, the absence of any evidence of malingering, the fact that Drs. Smith and Turok did not examine John, and the fact that MetLife has an inherent conflict of interest because it both administers and funds the Plan, the Court concluded that, “MetLife abused its discretion in denying [John’s] claim for benefits.”
Conclusion
This is my third consecutive blog-posting on separate court holdings in three different jurisdictions that MetLife had abused its discretion in denying LTD benefits. MetLife’s abusive practices are in my opinion systemic and nationwide. Those three court decisions provide for full remedies and attorney fees but, until punitive damages are allowed under ERISA claims like this, I expect MetLife to continue its abuse of the disabled with impunity.
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.
