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Michigan Court Finds MetLife Wrongfully Denied Benefits

In 2007, a federal court in Michigan held that an insured was entitled to continue to receive disability benefits.

Service Technician Disability Benefits Terminated

The insured worked at Sears Roebuck as a service technician from 1971 to 2000. On December 1, 2001, he was forced to stop working because a herniated disc caused him pain and reduced his mobility.

He filed a claim for short-term benefits. It was approved. He submitted a claim for long-term benefits. It was also approved. However, just eight months later, MetLife terminated his benefits.

MetLife terminated the benefits because of an “independent” physician consult who, although he had never examined or treated the insured, by reviewing medical records alone determined the insured would be able to return to work.

Service Technician Appeals, Benefits Reinstated, Terminated Again

The insured appealed MetLife’s decision to terminate his benefits. He provided MetLife with an evaluation his treating physician completed for his social security claim. He also pointed out several errors the “independent” physician made.

As a result of his appeal, MetLife reinstated his benefits. Yet, eleven months later, MetLife had another consultation, this time by a different “independent” physician. This doctor also had never examined or treated the insured yet found he could return to work. MetLife terminated his benefits again and the insured appealed again.

In his second appeal, he had his treating physician explain that the insured’s back condition had not improved. In response, MetLife had a third “independent” physician conduct an additional consultation who, again without examining or treating the insured, determined that he could return to work.

Second Appeal is Denied, MetLife is Sued

MetLife denied the second appeal and the insured sued in federal court. The court held that MetLife decision to terminate benefits was arbitrary and capricious and reinstated the insured’s benefits.

It reached its decision by observing that every retained physician’s determination that the insured could work was not based upon actual medical evidence. That MetLife had the opportunity to obtain medical evidence through a physical medical examination yet chose not to.

Insurance Companies Can and Will Arbitrarily Terminate Benefits

Many insurance companies will terminate benefits even when an insured is still disabled. Unfortunately, like this case, insurance companies often make repeated attempts to terminated benefits throughout the course of the claim.

We have handled many cases where insurance companies have repeatedly attempted to terminate a client’s benefits even when they remain unable to work. Because this happens all to often, we also represent our clients and continue to monitor their cases even after their benefits have been granted.

Disability Insurance Companies Have Lawyers. Shouldn’t You?

Because this law firm was founded to focus on disability insurance, we have developed a proven track record of success in this difficult area of law. We have:

All of our lawyers commit every day of their legal career to helping people get disability benefits from major insurance companies.

Because federal law applies to most disability insurance claims, we do not have to be located in your state to help. We help clients nationwide.

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