Raleigh, North Carolina
Our client, a U.S. Veteran who had served over seven years before an honorable discharge, was insured by Met Life through his employer where he worked for several years as a commercial truck driver. Unfortunately, when his chronic lumbar and cervical cord pain reached the point he could no longer perform his job duties, he applied for disability benefits with Met Life.
Met Life agreed with the Veteran’s Administration (VA) and approved his short and long-term disability benefits. However, after paying disability benefits for 2 years, Met Life abruptly terminated any further payments. Met Life based its decision on a limitation in the insurance policy that limited disability benefits to a maximum of 2 years. The problem is that Met Life’s denial ignored the treating physician’s objective findings of radiculopathies – findings that precluded Met Life’s use of the 24-month limitation.
Met Life subsequently failed to respond to our client’s appeal within the required 45 days. In addition, when it denied the appeal, Met Life continued to ignore the treating physician’s findings and raised a completely new reason for denying the claim based on another policy exclusion.
With Grabhorn Law’s assistance, an ERISA lawsuit was filed challenging Met Life’s improper termination of our client’s long-term disability benefits. In particular, the lawsuit challenged Met Life’s disregard of the treating physician’s findings, its failure to issue a timely appeal decision, and its failure to provide a full-and-fair review (by raising a new reason for its denial on appeal). Prior to the lawsuit being resolved by the court, Met Life requested the parties participate in an early settlement mediation. The case was subsequently confidentially settled to our client’s satisfaction.