Prior to becoming disabled, our client worked as a quality analyst testing financial software. While employed, she was covered by a long-term disability insurance policy issued by Met Life. Unfortunately, as the result of her physical limitations and restrictions resulting from breast cancer and subsequent neuropathies (pain), she could no longer perform her job duties and she applied for disability under the Met Life policy. Met Life approved her claim and paid her monthly long-term disability benefits for roughly 13 months. Unfortunately, without any improvement in her disabling condition, Met Life terminated her long-term disability benefits.
With Grabhorn Law’s assistance, a detailed and thorough appeal was filed providing additional medical support as well as identifying the problem with Met Life’s denial decision. Because the long-term disability insurance policy was subject to ERISA, Met Life was required to provide a decision on the appeal within 45 days. When Met Life failed to issue a timely decision, an ERISA lawsuit was filed challenging Met Life’s improper termination of long-term disability benefits.
Met Life actively sought to avoid responding to our client’s lawsuit. First, it sought to move the lawsuit to a court it thought would be more favorable. Met Life then sought to dismiss the lawsuit because it insisted our client had not exhausted her appeals. Met Life denied it failed to render a timely decision and that it should be permitted another chance. Fortunately, the court saw through Met Life’s flawed arguments, denied Met Life’s motion to dismiss the lawsuit, and ordered Met Life to respond (file an answer) to the lawsuit. In finding against Met Life, the court accepted Grabhorn Law’s arguments noting that “MetLife did not point to any evidence that it was engaged in an on-going exchange of information that justified its delay in resolving her appeal.” In short, Met Life did not have a reasonable excuse for not deciding the appeal.
Faced with having to answer the ERISA complaint, and faced with the overwhelming evidence supporting the claim, Met Life finally approved the claim. The monthly disability insurance benefits were reinstated, retroactively paying past due benefits with accrued interest.