MetLife Reverses Long Term Disability Denial of Woman with Bipolar Disorder

This office was once again successful on behalf of a client whose disability benefits were wrongfully denied.  These long term disability benefits governed by the Employee Retirement Income Security Act (ERISA), and insured by MetLife, have now been reinstated.  Ms. S suffered from bipolar disorder, and had been receiving benefits for several years before MetLife callously and without notice terminated her claim.  In making its determination, MetLife ignored the clear opinions of Ms. S’s treating mental health care providers, and relied instead upon the opinion of an external reviewing physician who did not address the severity of Ms. S’s condition and did not take into account the letters written by Ms. S’s physicians.

Ms. S contacted our firm for assistance in preparing an ERISA long term disability appeal.  We obtained several pieces of supporting evidence in support of her disability, including opinion letters from her mental health care providers, demonstrating how and why the information MetLife had relied upon was incomplete and biased.  After presenting this material in a coherent appeal for submission to MetLife, the adverse benefits determination was overturned and Ms. S’s long-term disability benefits were reinstated. 

Our office will continue to oversee this claim for Ms. S with a goal to preventing a future denial of benefits. 

If you need assistance in submitting a thorough, well-prepared ERISA disability appeal, or require assistance with a claim under your private long term disability insurance policy, please contact the Law Office of ShawnE. McDermott.

Colorado PERA Second Level Appeal

In a prior blog post, I reported that the PERA Disability Program Administrator, Unum Life Insurance Company of America (Unum Group), was rendering claim decisions in disregard of the terms of the policy that has been issued to Colorado PERA with regard to Short Term Disability benefits.  In a deposition of the Director of PERA’s Benefits Services at Unum a few weeks ago, we learned that PERA itself is very concerned over the way in which Unum has handled claims for disability benefits since January 1, 2011.  This PERA Director agreed that Unum handled our client’s disability claim and the internal appeal process in a way which violated the terms of the Short Term Disability Policy.  More particularly, Unum Insurance is required to inform denied PERA members of the member’s right to request a second level of review.  This second level of review is to be conducted by a “panel of independent experts.”  It is our belief that Unum was not aware of its own policy requirement until we conducted depositions in our client’s case.  As a result, it is plainly obvious that Unum has now altered the way in which it is handling PERA claims.  We have since received follow up letters on behalf of other clients wherein they have now been informed of their right to request a second level of review. 

It remains to be seen how Unum handles such second level of reviews in the future.  These reviews are to be conducted by “independent” experts.  Well, we will see how independent they truly are.  Our suspicion is that Unum will simply send the medical records of the denied PERA members to physicians of their choosing for additional medical records reviews only.  In our past experience, these so-called independent experts are not so independent, have worked with Unum quite frequently, and of course are compensated by Unum to conduct such reviews and render opinions concerning a person’s ability to work or not. 

What we do know is that Unum has clearly changed its policies with regard to the handling of PERA claims as a result of litigation we are pursuing on behalf of a disabled client whose benefits were wrongfully denied.  Whether wrongfully denied or even unreasonably delayed, you may wish to have your claim reviewed by attorneys who specialize in this area of the law.  

Unum Insurance is Mishandling Colorado PERA Disability Claims

We have recently discovered a major failing in the way UnumInsurance is administering and deciding Colorado PERA disability claims.  If you are reading this blog, you are likely aware that Unum Insurance is the disability program administrator for the Colorado Public Employee Retirement Association (Colorado PERA) DisabilityProgram. This is a two-tiered disability program which entitles disabled PERA members to either short term disability or disability retirement.  Unum took over the role as the administrator from the prior administrator, Standard Insurance Company, on January 1, 2011.  We have a couple of PERA member clients whose disability claims have been denied by Unum whose right to a complete review of their claim was not provided in accordance with the law.  The Colorado PERA statutes, the PERA Rules, and the PERA short term disability policy issued by Unum to PERA guarantees the right to a second level of review of a denied claim which is to be completed by a “panel of independent experts.”  This final level of review is to be a “medical review.” This office has reviewed a few situations recently where the claim for disability was denied by Unum, the appeal of the denial which was submitted by the member to Unum was also denied, but the final appeal decision letter (which Unum refers to as an “uphold” letter) did not contain the required statement that the PERA member may request a second level of review.  This final level of review was never offered to a few of our clients.  In our opinion, the failure to offer a review that is mandated by the policy and Colorado Law constitutes improper claims handling and results in both an unreasonable delay and unreasonable denial of the PERA member’s disability claim.  If deemed unreasonable, the denial can result in a doubling of the contract benefit owed along with an award of attorney’s fees in favor of the denied PERA member. 

If you have experienced a similar situation, or feel that your denied PERA disability claim should be reviewed by an attorney, feel free to contact our office for an initial consultation.

PERA SHORT TERM DISABILITY BENEFIT CASE ARGUED TO THE COURT OF APPEALS

Shawn E. McDermott presented oral argument to a panel of the Colorado Court of Appeals on the appropriateness of Colorado PERA’s (and Standard Insurance Company’s former) administration of the short term disability program, on behalf of three clients whose cases had been consolidate for the appeal.  One of these cases seeks class action certification.  We expect a written decision to be entered within the next one to three months.  The case involves our request that the Court strike subsection E of PERA Rule 7.45 which contains the requirement that a PERA Member show the inability to earn 75% of his or her predisability earnings in some other job as a prerequisite to being entitled to short term disability benefits.  If eligible for PERA STD payments, a PERA Member is entitled to 60% of predisability earnings for up to 22 months. 

It has been our position for several years now that Rule7.45(E) is not consistent with the definition of short term disability found in the statute, C.R.S. 25-41-702(1)(a).  Click here to read prior posts on this issue.  We of course cannot predict how the Court of Appeals will rule, but if the decision is in the favor of the Appellants, then the PERA Rule is revised and the short term disability policy will likely be reformed to remove the “second prong” of the definition.  Moving forward, PERA Members will only have to prove the inability to do their own job in order to be entitled to short term disability benefits, which the statute provides.

We continue to be amazed that Colorado PERA fights our clients on this issue.  In our opinion, the law could not be any clearer, and the way in which the PERA administrator, formerly Standard Insurance Company and now Unum Insurance, is administering these disability claims.