MetLife Approves Disability Insurance Benefits for Sufferer of Multiple Orthopedic Ailments

Our firm was recently successful in obtaining long-term disability benefits for a client insured by MetLife.  Ms. R suffered from acute back pain which included cervical spondylosis, cervicalgia, and migraines.  She also suffered from various sleep problems, which only made her spinal pain worse.  After determining she was unable to perform the duties of her own occupation, Ms. R ceased working and submitted a claim for long-term disability benefits to MetLife.  After reviewing medical documentation, MetLife concurred she was unable to work and approved her claim.  After receiving benefits for only five months, MetLife cut her off, alleging she no longer met its definition of disability.  Her disability benefits were cut off when she needed them most.  MetLife provided no basis for its termination, other than a written report prepared by its in-house physician.

Ms. R contacted our firm seeking assistance in filing an appeal of MetLife’s adverse benefits determination, which is required of all claims governed by the Employee Retirement Income Security Act (“ERISA”).  We obtained pursued several pieces of documentation, including a Functional Capacity Evaluation, supporting letters from her treating physician  and other relevant evidence supporting her claim.  Our appeal resulted in MetLife reversing its prior decision to terminate benefits.  Her monthly disability benefits have now been restored without the need of a lawsuit. 

Ms. R contacted the Law Office of Shawn E. McDermott to assist in the filing of his appeal of denied benefits, to ensure the proper presentation of his claim to the insurance company. Attorney Heather Petitmermet and Legal Assistant Emily Fourcroy worked on her claim, gathering and analyzing information they knew would be needed by the insurance companies in order to establish her claim for benefits.  These efforts paid off rather quickly for our client. 

ERISA HEARSAY AND SANCTIONS

Experience of Counsel is Important

A local federal district court judge, Judge Brooke Jackson, recently issued a decision in an ERISA case confirming sanctions against the attorney representing the Plaintiff whose long term disability payments had been denied by The Prudential Insurance Company of America (“Prudential”).  While I do not wish to blog about the specific abilities of the attorney who was representing the Plaintiff in this case, the slip opinion issuing an order on the various pending motions on that case reveals what Judge Jackson referred to as the inexperience and inadequacy of counsel in representing the Plaintiff in this ERISA-governed claim.  The actions of counsel resulted in an award of several thousands of dollars in favor of the Defendant Plan, which were to be paid by the counsel for Plaintiff.  The lesson to be learned is to ensure that you hire truly experienced counsel in handling your Colorado ERISA long term disability claim or denial, and pursuing ERISA litigation if it becomes necessary.  The slip opinion is attached below.

Hearsay

The opinion of Judge Jackson is relevant to issues we have faced in the past in that the Judge specifically commented on the issue of inadmissible hearsay.  Our office has been required to address this issue in the past.  We have experienced Defendant Plans or insurance companies argue that certain documents submitted by the ERISA disability claimant (often times with our assistance during the internal appeal) are either inappropriate or constitute inadmissible hearsay.  We have always opposed such argument with regard to evidence submitted by the claimant.  Judge Jackson’s order in the attached case clarifies, at least in his opinion, that ERISA disability litigation is different, and what may be considered hearsay in an otherwise ordinary litigation would not be considered hearsay in ERISA litigation.  That is because the typical rules of evidence do not apply to what may or may not be considered in evaluating a long term disability claim.  Whenever this arises in the future, we now have the ability to cite to at least one judge’s clear opinion on this issue in the future.

If you are in need of experienced counsel to review your long term disability insurance and to obtain an honest and forthright opinion about the potential success of your denied benefit and the proper steps to be followed, please feel free to contact the Colorado ERISA disability attorneys at the Law Office of Shawn E. McDermott.  We can be reached at (303) 964-1800.