Despite lumbar surgery in February 2017, our New York City, NY client had to end his IT manager career in October of the same year due to his increasing back pain. His symptoms were so severe that his doctors recommended a spinal cord stimulator.
MetLife approved our client’s long-term disability (LTD) benefits and provided monthly payments for over three years until November 2021. The company suddenly changed course and terminated our client’s benefits without any valid reason.
Baffled by MetLife’s irresponsible decision, our client reached out to Dabdoub Law Firm to help him appeal the wrongful termination.
Medical Records Have Clearly Demonstrated Our Client’s Disability for Several Years
MetLife has received substantial medical evidence establishing our NYC client’s disability since his medical history has always shown his inability to perform any professional duties.
Documents MetLife has in its possession include:
- An EMG confirming radiculopathy and carpal tunnel syndrome
- A lumbar MRI confirming severe disc bulges and disc herniations (July 2017)
- A cervical MRI revealing disc bulges, progressive foraminal stenosis, and nerve root impingement (March 2018)
- Brain MRI establishing multiple abnormalities (March 2018)
- A cervical MRI showing disc bulges and “severe foraminal stenosis bilaterally” (March 2021)
- A lumbar MRI revealing disc bulges, some with nerve root impingement (April 2021)
An updated CT scan of our client’s spine confirmed disc herniation, disc bulges, nerve compression, nerve root impingement, and disc protrusion. Doctors have recommended a spinal fusion.
In addition to chronic back pain, our client experiences frequent migraines which further interfere with his daily life. His neurologist performs regular Botox injections to alleviate the severity of his symptoms, including nausea, fatigue, and vomiting. However, our client’s migraines still range from a 5 to 10 pain level.
His pain management specialist confirmed debilitating pain and the need for regular epidural steroid injections to provide minimal and temporary relief.
Our Client’s Functional Capacity Evaluation Leaves No Doubt About His Disability
In the hope to make MetLife come to its senses, our client underwent a functional capacity evaluation (FCE) in March 2022. This type of medical evaluation is commonly used in disability insurance claims and professionals and courts consider it an accurate method. Physical therapists who perform FCEs are licensed professionals that can properly assess someone’s health and ability or lack thereof to hold full-time employment.
The physical therapist who handled our client’s FCE concluded that he “falls below the sedentary category and is not eligible for competitive gainful employment.” The medical provider also recommended that physical therapy could benefit our client “not with the goal of returning to work, but rather to improve his ability to perform basic activities of daily living.” Key results of our client’s FCE include a need to avoid sitting or standing, a fall risk, and gait issues.
An independent occupational therapist reviewed the FCE and considered the evaluation and its results valid and representative of our client’s abilities.
The FCE review confirmed the multiple work impairment causes, including:
- Cervical radiculopathy
- Lumbar radiculopathy
- Carpal tunnel syndrome
- Rotator cuff rupture
- Dependence on bilateral straight cane
- Reduced tolerance to sustained sitting beyond six minutes
Our client’s pain management specialist completed a form in May 2022 that also corroborated the results of the FCE. In this pain and physical capacity questionnaire, the specialist confirmed various medical diagnoses and our client’s constant and severe pain that interferes with not only physical activity but with the necessary attention and focus for even simple tasks.
MetLife’s Termination of Benefits Blatantly Dismissed Our Client’s Medical Evidence and Approval of SSDI Benefits
MetLife had recommended that our client applied for social security disability benefits (SSDI) following its approval of disability benefits with the company. Social Security Administration (SSA) indeed awarded SSDI to our client and continues to provide payments up to this day.
By ignoring not only the extensive medical evidence but our client’s SSDI benefits, MetLife breached its fiduciary duty under the Employee Retirement Income Security Act of 1974 (ERISA) which requires insurance providers to act in the policyholders’ and beneficiaries’ best interests.
MetLife even dismissed recent a recent medical report that confirmed that our client was at maximum medical improvement but continued to suffer from multiple issues and severe symptoms that prevented him from engaging in full-time sedentary work. Instead of doing their duty of evaluating medical evidence, MetLife preferred relying on paper-based reviews performed by paid consultants.
The insurance company’s irresponsible decision threatened our client’s financial resources and quality of life and showed a troubling lack of commitment to its fiduciary obligations.
Following our appeal and submission of additional medical evidence like the functional capability evaluation, MetLife reinstated our client’s LTD benefits in the summer of 2022.
Our Lawyers Specialize in Disability Insurance Claims
Dabdoub Law Firm has always focused only on disability insurance, so our attorneys offer top-quality counsel and representation for disability insurance benefits.
Our disability lawyers can help you secure the disability benefits you deserve because we have:
- Won several major disability lawsuits that help make better laws for disability claimants;
- Experience fighting every major insurance company, such as Lloyds of London, Aetna, CIGNA, Ameritas, Provident, The Guardian Life Insurance Company of America, and more.
- Successfully represented hundreds of clients and won millions of dollars in disability benefits.
Because federal law applies to most disability insurance claims, we can help clients across the country. No matter which state you live in, we can represent you.
Disability insurance companies have lawyers. You should too. Call us today at (800) 969-0488 to get experienced disability lawyers on your side with:
- Submitting a disability insurance claim;
- Appealing a long-term disability denial;
- Negotiating a lump-sum settlement; or
- Filing a lawsuit against your disability insurance company.
Contact Dabdoub Law Firm today at (800) 969-0488 to schedule a free consultation with one of our disability attorneys. No fees or costs unless we win your case, and you get paid.