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MetLife Restores LTD Benefits for Our Kansas City Client with Traumatic Brain Injury

Before her disability, our client from Kansas City, MO, was a successful Senior Manager of Independence where she was responsible for drafting and reviewing policies and procedures for cryptocurrency and reviewing and approving private investments made by the company’s partners.

A few years ago, her life drastically changed when a baseball struck her in the forehead while playing with her son and when she got another blow in the head while on vacation shortly after. When she returned to work, severe cognitive symptoms appeared such as confusion, difficulty reading, and dizziness.

Unable to keep working, our client submitted a claim for long-term disability (LTD) benefits with MetLife. Months later and beyond the mandatory deadlines under the Employee Retirement Income Security Act of 1974 (ERISA), MetLife denied the claim in July 2020.

In April 2021, our client appealed the denial and provided extensive medical and non-medical evidence supporting her disability claim. MetLife eventually approved the appeal in June 2021 after a full and fair review of the presented evidence.

However, the insurance company reversed course again at the end of October 2021 and unexpectedly terminated our client’s LTD benefits. It claimed that she was no longer disabled and could resume employment although no change had happened in her medical condition or noted in her medical records.

Shocked by MetLife’s new unfair decision that jeopardized her finances and well-being, our client reached out to Dabdoub Law Firm to appeal the termination of benefits.

MetLife’s Consulting Physicians Previously Confirmed Our Client’s Disability

In May 2021, MetLife’s consulting ophthalmologist and neurologist reviewed our client’s medical records and acknowledged multiple diagnoses, including:

These physicians also confirmed a wide range of symptoms like nausea, dizziness, blurred vision in our client’s right eye, cognitive impairments, and neck pains.

MetLife’s consulting doctors also confirmed that our client had the following limitations:

  • No working in loud environments
  • Limited screen time: Occasionally, for up to 30 minutes per day
  • Reading: Occasionally, for up to 30 minutes per day
  • No depth/distance calculation by vision

Our client’s previous occupation required the near-constant use of computers and close reading on paper or electronic screens. Her current conditions prevent her from doing any of those tasks. This led MetLife to approve our client’s original appeal in June 2021.

MetLife Made a Baseless Reversal of Course Although Our Client’s Health Had Not Improved

Although the insurance company had approved our client’s LTD benefits, it carried on additional reviews. In July 2021, its internal nurse consultant provided further information including surveillance conducted in March 2020, which was part of the records our client submitted for her initial appeal.

Based on this new evidence, the consulting ophthalmologist confirmed their previous conclusions, and the consulting neurologist provided the amended list of limitations:

  • Screen time: Occasionally, two hours total a day
  • Reading: Occasionally, two hours total a day
  • Written instructions available
  • Limit tasks in which decreased concentration would greatly affect the error rate
  • No work tasks involving a high level of comprehension and memory work
  • Occasional verbal communication, up to two hours total per day

With four medical reviews confirming our client’s inability to perform her previous occupation or any sedentary work, MetLife should have continued to make LTD benefit payments. However, the Nurse consultant sent reports back to the reviewers in August 2021 with additional surveillance footage from June 2021.

During the surveillance study, our client was only visible for less than two hours over the course of five days where she engaged in the following activities:

  • Having lunch outside with her son
  • Taking her children to the pool
  • Applying sunscreen on her children
  • Taking her daughter to camp or daycare
  • Pushing a stroller
  • Using her phone for no more than a couple of minutes

She was not seen reading or performing any task that required sustained use of her vision. This surveillance was still enough for MetLife’s consulting physicians to suddenly change their minds and determine that our client had no restrictions for professional or daily tasks.

MetLife Committed Claim Targeting When Terminating Our Client’s LTD Benefits

No matter how much additional evidence our client submitted to MetLife was sufficient for it to fulfill its fiduciary duties under ERISA. The insurance company had been set on undermining her claim and avoiding paying appropriate benefits since her original claim. It was determined to terminate our client’s benefits one way or another. MetLife used the same medical reports to approve and terminate her LTD benefits, which showed its focus on self-interests rather than doing the right thing.

Under ERISA, MetLife disregarded its obligations toward our client. Thankfully, Dabdoub Law Firm was able to secure the reinstatement of our client’s LTD benefits in the fall of 2022 after filing a second appeal, this time for the wrongful termination of benefits.

Disability Insurance Companies Have Lawyers. Shouldn’t You?

We created Dabdoub Law Firm to focus on disability insurance and have developed expertise in this complex area of the law.

Our expertise in long-term disability claims means our clients have the backing of attorneys who:

All our lawyers commit every day of their legal career to helping people get disability benefits from Aetna, Liberty, LifeMap Assurance Company, Provident, Northwestern Mutual, Lloyds of London, CIGNA, and other insurance providers.

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.

Call us today at (800) 969-0488 to get experienced disability lawyers on your side with:

Contact Dabdoub Law Firm today at (800) 969-0488 for a free consultation with a disability attorney. We only get paid if we win your case.